Healthcare Provider Details

I. General information

NPI: 1457895344
Provider Name (Legal Business Name): ENGIMA ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 11TH AVE S
NASHVILLE TN
37203-4021
US

IV. Provider business mailing address

226 11TH AVE S
NASHVILLE TN
37203-4021
US

V. Phone/Fax

Practice location:
  • Phone: 615-645-9680
  • Fax: 615-645-9782
Mailing address:
  • Phone: 615-645-9680
  • Fax: 615-645-9782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number35491
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number35491
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17482
License Number StateTN

VIII. Authorized Official

Name: DR. TRACI M POOLE
Title or Position: CEO
Credential: PHARM.D.
Phone: 615-645-9680