MEDICARE: ERIC LOCKNER

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	0000037385	TN

General Provider Information

NPI Number	:	1639798861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC LOCKNER

Provider Business Mailing Address
First Line	:	821 RANGEWOOD RD
Second Line	:
City	:	PINEY FLATS
State	:	TN
Zip	:	37686-4543
Country	:	US
Telephone Number	:	423-797-0082
Fax Number	:

Provider Business Practice Location Address
First Line	:	1940 S ROAN ST
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-7559
Country	:	US
Telephone Number	:	423-979-2204
Fax Number	:

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

Provider Enumeration Date	:	04/08/2020
Last Update Date	:	04/08/2020

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Directions to “ ERIC LOCKNER ” Practice Location

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