Healthcare Provider Details

I. General information

NPI: 1942229448
Provider Name (Legal Business Name): DARLA TESS LAXTON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TESS LAXTON SMITH PHARMD

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20029 ALBERTA ST
ONEIDA TN
37841-3501
US

IV. Provider business mailing address

PO BOX 4129
ONEIDA TN
37841-4129
US

V. Phone/Fax

Practice location:
  • Phone: 423-569-8652
  • Fax: 423-569-4080
Mailing address:
  • Phone: 423-223-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26962
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: