Healthcare Provider Details

I. General information

NPI: 1134104102
Provider Name (Legal Business Name): EDWIN HUDSON VARNADOE JR. PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

1400 MARCONI DR
KNOXVILLE TN
37909-1031
US

V. Phone/Fax

Practice location:
  • Phone: 865-544-6703
  • Fax: 865-544-8242
Mailing address:
  • Phone: 865-693-8504
  • Fax: 865-544-8242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number6176
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number11551
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: