MEDICARE: BENJAMIN THOMAS LOOMIS PHARM.D.

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	33750	TN

General Provider Information

NPI Number	:	1407130685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN THOMAS LOOMIS PHARM.D.

Provider Business Mailing Address
First Line	:	7425 TAZEWELL PIKE
Second Line	:
City	:	CORRYTON
State	:	TN
Zip	:	37721-3532
Country	:	US
Telephone Number	:	865-232-1811
Fax Number	:	865-232-1817

Provider Business Practice Location Address
First Line	:	7425 TAZEWELL PIKE
Second Line	:
City	:	CORRYTON
State	:	TN
Zip	:	37721-3532
Country	:	US
Telephone Number	:	865-232-1811
Fax Number	:	865-232-1817

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

Provider Enumeration Date	:	10/05/2011
Last Update Date	:	10/05/2011

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