Provider Demographics
NPI:1427785823
Name:MOORE, TANNER B (PHARM D)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:B
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5311 SW 22ND PL
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-1500
Mailing Address - Country:US
Mailing Address - Phone:785-228-8762
Mailing Address - Fax:
Practice Address - Street 1:5311 SW 22ND PL
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-1500
Practice Address - Country:US
Practice Address - Phone:785-228-8762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-107189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist