Healthcare Provider Details

I. General information

NPI: 1801179643
Provider Name (Legal Business Name): MARK STEPHEN HOFFMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1943 BERRYHILL RD
CORDOVA TN
38016-5311
US

IV. Provider business mailing address

1943 BERRYHILL RD
CORDOVA TN
38016-5311
US

V. Phone/Fax

Practice location:
  • Phone: 901-757-0526
  • Fax: 901-757-5193
Mailing address:
  • Phone: 901-757-0526
  • Fax: 901-757-5193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number08545
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number08545
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: