Healthcare Provider Details

I. General information

NPI: 1417060393
Provider Name (Legal Business Name): LISA BRANNON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 EXECUTIVE PARK DR STE A203
KNOXVILLE TN
37923-4653
US

IV. Provider business mailing address

126 VISTA POINTE DR
KINGSTON TN
37763-6858
US

V. Phone/Fax

Practice location:
  • Phone: 865-531-0008
  • Fax: 865-531-0058
Mailing address:
  • Phone: 865-531-0008
  • Fax: 865-531-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7958
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: