Provider Demographics
NPI:1548814213
Name:BUCHOLZ, TANNER COLE (PHARMD)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:COLE
Last Name:BUCHOLZ
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 1:921 E DEL RIO ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8156
Mailing Address - Country:US
Mailing Address - Phone:480-293-4124
Mailing Address - Fax:
Practice Address - Street 1:1919 N DOBSON RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2237
Practice Address - Country:US
Practice Address - Phone:480-899-6713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist