Healthcare Provider Details

I. General information

NPI: 1801056577
Provider Name (Legal Business Name): THERON NEAL FOURAKRE RPH, PHARMD, BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 LEBANON RD VA-TENNESSEE VALLEY HEALTHCARE SYSTEM-PHARMACY DEPT. (1
MURFREESBORO TN
37129-1237
US

IV. Provider business mailing address

3400 LEBANON RD VA-TENNESSEE VALLEY HEALTHCARE SYSTEM-PHARMACY DEPT. (1
MURFREESBORO TN
37129-1237
US

V. Phone/Fax

Practice location:
  • Phone: 615-225-5378
  • Fax:
Mailing address:
  • Phone: 615-225-5378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0000023959
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number23959
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: