Healthcare Provider Details

I. General information

NPI: 1598817066
Provider Name (Legal Business Name): MIKE PEPPER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 MEMORIAL BLVD
MURFREESBORO TN
37129-1522
US

IV. Provider business mailing address

166 VOLUNTEER RD
MURFREESBORO TN
37128-6209
US

V. Phone/Fax

Practice location:
  • Phone: 615-895-0186
  • Fax: 615-278-3355
Mailing address:
  • Phone: 615-895-0186
  • Fax: 615-278-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8879
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: