Healthcare Provider Details

I. General information

NPI: 1710299987
Provider Name (Legal Business Name): ERIN JANELLE WANNER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN JANELLE WANNER RPH

II. Dates (important events)

Enumeration Date: 07/05/2010
Last Update Date: 07/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 25TH ST NW
CLEVELAND TN
37311-3830
US

IV. Provider business mailing address

3400 JENKINS RD APT 624
CHATTANOOGA TN
37421-1162
US

V. Phone/Fax

Practice location:
  • Phone: 423-614-4810
  • Fax: 423-614-5397
Mailing address:
  • Phone: 865-384-6546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number6741719
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: