Healthcare Provider Details

I. General information

NPI: 1336805209
Provider Name (Legal Business Name): PATRICIA ELLEN STONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 11/15/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 SPRING STREET
ERIN TN
37061
US

IV. Provider business mailing address

PO BOX 227
ERIN TN
37061-0227
US

V. Phone/Fax

Practice location:
  • Phone: 931-289-4231
  • Fax:
Mailing address:
  • Phone: 931-289-4231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0000000195
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: