Healthcare Provider Details

I. General information

NPI: 1982520979
Provider Name (Legal Business Name): MARISSA OLIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 W STATE OF FRANKLIN RD
JOHNSON CITY TN
37604-8801
US

IV. Provider business mailing address

1805 W STATE OF FRANKLIN RD
JOHNSON CITY TN
37604-8801
US

V. Phone/Fax

Practice location:
  • Phone: 423-929-1408
  • Fax:
Mailing address:
  • Phone: 423-929-1408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number48251
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: