Healthcare Provider Details

I. General information

NPI: 1558858530
Provider Name (Legal Business Name): MADENA RENAE STARCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7550 NORRIS FWY
KNOXVILLE TN
37938-4221
US

IV. Provider business mailing address

1579 MAREMONT RD
KNOXVILLE TN
37918-0937
US

V. Phone/Fax

Practice location:
  • Phone: 865-922-6036
  • Fax: 865-925-3122
Mailing address:
  • Phone: 865-660-9479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number11414
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: