Healthcare Provider Details

I. General information

NPI: 1194812446
Provider Name (Legal Business Name): TRITENN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 SUNCREST ST UNIT 1
JOHNSON CITY TN
37615-3494
US

IV. Provider business mailing address

208 SUNCREST ST UNIT 1
JOHNSON CITY TN
37615-3494
US

V. Phone/Fax

Practice location:
  • Phone: 423-477-3847
  • Fax: 423-477-4392
Mailing address:
  • Phone: 423-477-3847
  • Fax: 423-477-4392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberC001007
License Number StateTN

VIII. Authorized Official

Name: JORDON THOMAS BAKER
Title or Position: CEO / CO-OWNER
Credential: PHARM D.
Phone: 423-772-3591