Healthcare Provider Details

I. General information

NPI: 1407317563
Provider Name (Legal Business Name): ANDREA MCNALLEY GERWIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 E 3RD ST
CHATTANOOGA TN
37403-2147
US

IV. Provider business mailing address

300 E BROW RD
LOOKOUT MOUNTAIN TN
37350-1212
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-2190
  • Fax:
Mailing address:
  • Phone: 205-492-5453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number0000034520
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number0000034520
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number0000034520
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number0000034520
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: