Healthcare Provider Details

I. General information

NPI: 1366852444
Provider Name (Legal Business Name): JONATHAN LISTER RPH,PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 24TH AVE S
NASHVILLE TN
37212
US

IV. Provider business mailing address

1310 24TH AVE S
NASHVILLE TN
37212-2637
US

V. Phone/Fax

Practice location:
  • Phone: 615-873-6776
  • Fax:
Mailing address:
  • Phone: 615-873-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37525
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number37525
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: