MEDICARE: CHESNEY GANNAWAY PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	34377	TN

General Provider Information

NPI Number	:	1255818860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHESNEY GANNAWAY PHARMD

Provider Business Mailing Address
First Line	:	113 HERITAGE CT
Second Line	:
City	:	JONESBOROUGH
State	:	TN
Zip	:	37659-5878
Country	:	US
Telephone Number	:	423-276-5220
Fax Number	:

Provider Business Practice Location Address
First Line	:	4470 N ROAN ST
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37615-4922
Country	:	US
Telephone Number	:	423-282-0055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2018
Last Update Date	:	07/26/2018

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Directions to “ CHESNEY GANNAWAY PHARMD” Practice Location

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