Healthcare Provider Details

I. General information

NPI: 1891101788
Provider Name (Legal Business Name): ANDREW MASSELINK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2419 WASHINGTON PIKE
KNOXVILLE TN
37917-3321
US

IV. Provider business mailing address

2419 WASHINGTON PIKE
KNOXVILLE TN
37917-3321
US

V. Phone/Fax

Practice location:
  • Phone: 865-524-3453
  • Fax: 865-524-9925
Mailing address:
  • Phone: 865-524-3453
  • Fax: 865-524-9925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: