Provider Demographics
NPI:1538610472
Name:ZIMMER, TANNER (PHARMD)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:ZIMMER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2500
Mailing Address - Country:US
Mailing Address - Phone:406-587-0608
Mailing Address - Fax:406-587-1375
Practice Address - Street 1:910 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2500
Practice Address - Country:US
Practice Address - Phone:406-587-0608
Practice Address - Fax:406-587-1375
Is Sole Proprietor?:No
Enumeration Date:2016-10-15
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA4930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist