Healthcare Provider Details

I. General information

NPI: 1295480382
Provider Name (Legal Business Name): JERRY MICHAEL MCGUIRE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 QUAIL HOLLOW CIR
FRANKLIN TN
37067-5967
US

IV. Provider business mailing address

1900 BELMONT BLVD
NASHVILLE TN
37212-3757
US

V. Phone/Fax

Practice location:
  • Phone: 314-705-1639
  • Fax:
Mailing address:
  • Phone: 615-460-5723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number37109
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: