Healthcare Provider Details

I. General information

NPI: 1083492706
Provider Name (Legal Business Name): LYDIA BORAH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 CHAPMAN HWY
KNOXVILLE TN
37920-4255
US

IV. Provider business mailing address

2316 SETTLERS RIDGE LN
KNOXVILLE TN
37931-5931
US

V. Phone/Fax

Practice location:
  • Phone: 865-573-0081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number47595
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: