Healthcare Provider Details

I. General information

NPI: 1366430613
Provider Name (Legal Business Name): LAURA NICOLE BULLOCK PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 ALCOA HWY STE E180
KNOXVILLE TN
37920-2263
US

IV. Provider business mailing address

1924 ALCOA HWY BOX U-41
KNOXVILLE TN
37920-1511
US

V. Phone/Fax

Practice location:
  • Phone: 865-544-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number22088
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0000022088
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number22088
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: