Healthcare Provider Details

I. General information

NPI: 1174677728
Provider Name (Legal Business Name): DEBORAH FAYE RYE PHARMACY TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 S RIVERSIDE DR
CLARKSVILLE TN
37040-4303
US

IV. Provider business mailing address

1051 S RIVERSIDE DR
CLARKSVILLE TN
37040-4303
US

V. Phone/Fax

Practice location:
  • Phone: 931-645-2494
  • Fax: 931-551-8294
Mailing address:
  • Phone: 931-645-2494
  • Fax: 931-551-8294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number17837
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: