Healthcare Provider Details

I. General information

NPI: 1184469256
Provider Name (Legal Business Name): WILLOW BRYCE SUTTON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 NEW YORK AVE
OAK RIDGE TN
37830-6410
US

IV. Provider business mailing address

1520A TAYLOR ST
COLUMBIA SC
29201-2919
US

V. Phone/Fax

Practice location:
  • Phone: 865-298-8657
  • Fax:
Mailing address:
  • Phone: 803-256-3440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60180
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48152
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: