Provider Demographics
NPI:1427166149
Name:BARRETT & TANNER, INC.
Entity type:Organization
Organization Name:BARRETT & TANNER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DELORA
Authorized Official - Middle Name:CRANFORD
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:336-963-1035
Mailing Address - Street 1:17941 S HWY 109
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27239
Mailing Address - Country:US
Mailing Address - Phone:336-859-2191
Mailing Address - Fax:336-859-2192
Practice Address - Street 1:17941 S NC HIGHWAY 109
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:NC
Practice Address - Zip Code:27239-6533
Practice Address - Country:US
Practice Address - Phone:336-859-2191
Practice Address - Fax:336-859-2192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04903332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700226Medicaid
NC0268930001Medicare ID - Type Unspecified