Healthcare Provider Details

I. General information

NPI: 1588574222
Provider Name (Legal Business Name): ANGELYN MARIE COCKRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELYN MARIE WILSON

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139E ACKLEN AVE
NASHVILLE TN
37212-3501
US

IV. Provider business mailing address

2139E ACKLEN AVE
NASHVILLE TN
37212-3501
US

V. Phone/Fax

Practice location:
  • Phone: 615-421-6671
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50296
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: