Healthcare Provider Details

I. General information

NPI: 1790989887
Provider Name (Legal Business Name): PHILLIP JASON SMITH PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4062 HIXSON PIKE
CHATTANOOGA TN
37415-3110
US

IV. Provider business mailing address

956 SIGNAL RD
SIGNAL MOUNTAIN TN
37377-3082
US

V. Phone/Fax

Practice location:
  • Phone: 423-877-3568
  • Fax: 423-877-2111
Mailing address:
  • Phone: 423-421-6906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23929
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: