Healthcare Provider Details

I. General information

NPI: 1629475587
Provider Name (Legal Business Name): JOHN EWING III PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W JACKSON BLVD
JONESBOROUGH TN
37659-5294
US

IV. Provider business mailing address

1200 W JACKSON BLVD
JONESBOROUGH TN
37659-5294
US

V. Phone/Fax

Practice location:
  • Phone: 423-753-9730
  • Fax: 423-753-4326
Mailing address:
  • Phone: 423-753-9730
  • Fax: 423-753-4326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number38666
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: