Healthcare Provider Details

I. General information

NPI: 1952134843
Provider Name (Legal Business Name): JORDAN WHALEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 KINGSTON PIKE
KNOXVILLE TN
37919-6346
US

IV. Provider business mailing address

1113 TINSLEY LN
DANDRIDGE TN
37725-4820
US

V. Phone/Fax

Practice location:
  • Phone: 865-588-5156
  • Fax:
Mailing address:
  • Phone: 865-654-8699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48330
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: