Healthcare Provider Details

I. General information

NPI: 1336438985
Provider Name (Legal Business Name): RALLIE DEANN HURLEY PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOREST DR
JONESBOROUGH TN
37659-1510
US

IV. Provider business mailing address

1921 HIGHWAY 394
BLOUNTVILLE TN
37617-5454
US

V. Phone/Fax

Practice location:
  • Phone: 423-753-3468
  • Fax:
Mailing address:
  • Phone: 423-323-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0000023969
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: