Healthcare Provider Details

I. General information

NPI: 1619708401
Provider Name (Legal Business Name): SHONDA ALIA BAILEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 PARKWAY
PIGEON FORGE TN
37863-3228
US

IV. Provider business mailing address

7624 SAGEFIELD DR
KNOXVILLE TN
37920-9223
US

V. Phone/Fax

Practice location:
  • Phone: 865-429-6410
  • Fax:
Mailing address:
  • Phone: 304-406-3961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48182
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: