Healthcare Provider Details

I. General information

NPI: 1417942699
Provider Name (Legal Business Name): DAVID W STEWART PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N STATE OF FRANKLIN RD
JOHNSON CITY TN
37604-6035
US

IV. Provider business mailing address

101 HIGHLAND GATE DR
JOHNSON CITY TN
37615-4494
US

V. Phone/Fax

Practice location:
  • Phone: 423-431-6111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number29326
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: