Healthcare Provider Details

I. General information

NPI: 1720778178
Provider Name (Legal Business Name): JONATHAN TRUETT ROACH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7326 MAYNARDVILLE PIKE
KNOXVILLE TN
37938-3717
US

IV. Provider business mailing address

2723 ANDOVER HILL WAY APT 4303
KNOXVILLE TN
37931-3758
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9868
  • Fax:
Mailing address:
  • Phone: 865-257-3285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number45206
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: