Healthcare Provider Details

I. General information

NPI: 1336561950
Provider Name (Legal Business Name): JACOB STOUT PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 WESTERN AVE
KNOXVILLE TN
37921-5718
US

IV. Provider business mailing address

926 MAIN ST
WARTBURG TN
37887-4199
US

V. Phone/Fax

Practice location:
  • Phone: 865-934-6786
  • Fax:
Mailing address:
  • Phone: 423-346-3505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37478
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: