Healthcare Provider Details

I. General information

NPI: 1790307353
Provider Name (Legal Business Name): AMANDA GAYLE JEWETT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2020
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3343 BONDWOOD CIR
JOHNSON CITY TN
37604-8904
US

IV. Provider business mailing address

3343 BONDWOOD CIR
JOHNSON CITY TN
37604-8904
US

V. Phone/Fax

Practice location:
  • Phone: 405-822-2375
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48332
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: