Healthcare Provider Details

I. General information

NPI: 1063748358
Provider Name (Legal Business Name): CHAD KEITH GENTRY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 MURFREESBORO PIKE
NASHVILLE TN
37210-2838
US

IV. Provider business mailing address

411 MURFREESBORO PIKE
NASHVILLE TN
37210-2838
US

V. Phone/Fax

Practice location:
  • Phone: 615-259-5124
  • Fax:
Mailing address:
  • Phone: 423-431-8820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number33092
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: