Healthcare Provider Details

I. General information

NPI: 1033203666
Provider Name (Legal Business Name): MICHAEL JEFFERSON USERY D.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 WESTSIDE DR
CLEVELAND TN
37312
US

IV. Provider business mailing address

3723 SPRINGDALE DR
CLEVELAND TN
37312
US

V. Phone/Fax

Practice location:
  • Phone: 423-559-3000
  • Fax: 423-559-3007
Mailing address:
  • Phone: 423-479-9461
  • Fax: 423-559-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberC-513
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: