Healthcare Provider Details

I. General information

NPI: 1124747068
Provider Name (Legal Business Name): ALI YASSER BAYDOUN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 CHAPMAN HWY
KNOXVILLE TN
37920-4255
US

IV. Provider business mailing address

1116 WALDEN LEGACY WAY APT 728
KNOXVILLE TN
37931-4784
US

V. Phone/Fax

Practice location:
  • Phone: 865-573-0081
  • Fax:
Mailing address:
  • Phone: 313-575-5737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number46480
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: