Healthcare Provider Details

I. General information

NPI: 1003736851
Provider Name (Legal Business Name): THEPPANYA ALEX AKHOM PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 ANTIOCH PIKE
ANTIOCH TN
37013-3311
US

IV. Provider business mailing address

1809 ANTIOCH PIKE
ANTIOCH TN
37013-3311
US

V. Phone/Fax

Practice location:
  • Phone: 615-832-1585
  • Fax: 615-832-9058
Mailing address:
  • Phone: 615-832-1585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50013
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: