Healthcare Provider Details

I. General information

NPI: 1750482998
Provider Name (Legal Business Name): RONNIE FELTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7164 WHITES CREEK PIKE
JOELTON TN
37080-8632
US

IV. Provider business mailing address

7164 WHITES CREEK PIKE
JOELTON TN
37080-8632
US

V. Phone/Fax

Practice location:
  • Phone: 615-876-0633
  • Fax: 615-876-0080
Mailing address:
  • Phone: 615-876-0633
  • Fax: 615-876-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number933
License Number StateTN

VIII. Authorized Official

Name: RONNIE FELTS
Title or Position: OWNER
Credential: DPH
Phone: 615-876-0633