Healthcare Provider Details

I. General information

NPI: 1710343173
Provider Name (Legal Business Name): JASON ANDERS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1167 HIGHWAY 49 S
RICHLAND MS
39218-4409
US

IV. Provider business mailing address

5201 N BROADWAY ST
KNOXVILLE TN
37918-2345
US

V. Phone/Fax

Practice location:
  • Phone: 601-664-0600
  • Fax: 601-664-0602
Mailing address:
  • Phone: 865-686-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number39664
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberT-16433
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: