Provider Demographics
NPI:1982582292
Name:TANNER, BRADLEY PHILLIP (RPH)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:PHILLIP
Last Name:TANNER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E F ST
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3442
Mailing Address - Country:US
Mailing Address - Phone:906-774-0563
Mailing Address - Fax:
Practice Address - Street 1:300 E F ST
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3442
Practice Address - Country:US
Practice Address - Phone:906-774-0563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302417513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist