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Tanner Tiedeman
NPI 1740779438 · on the registry since 2018
Practice
- Address
- 911 S Air Depot Blvd
Midwest City, OK 73110 - Phone
- (405) 737-3464
- Fax
- (405) 737-9554
- Organisation at this address
- Thomas Wilson Pharmacy Inc
Inferred from a shared address, not stated in the registry.
Registry record
- Primary taxonomy
- 183500000X
183500000X
- Licence states on file
- OK
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2018-05-08
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Oklahoma