Healthcare Provider Details

I. General information

NPI: 1821019886
Provider Name (Legal Business Name): NUTRITIONAL SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 SE PARKWAY STE 170
FRANKLIN TN
37064-3962
US

IV. Provider business mailing address

PO BOX 32249
KNOXVILLE TN
37930-2249
US

V. Phone/Fax

Practice location:
  • Phone: 615-591-1101
  • Fax: 615-435-2300
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberTN1173
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number201425
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number3289
License Number StateTN

VIII. Authorized Official

Name: TERRY LEEMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 615-591-1101