Healthcare Provider Details

I. General information

NPI: 1710075189
Provider Name (Legal Business Name): MRS. JERRIE STEWART ARUNTHAMAKUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 PARKWAY
PIGEON FORGE TN
37863-3310
US

IV. Provider business mailing address

3120 PARKWAY
PIGEON FORGE TN
37863-3310
US

V. Phone/Fax

Practice location:
  • Phone: 865-453-9096
  • Fax: 865-428-1970
Mailing address:
  • Phone: 865-453-9096
  • Fax: 865-428-1970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5576
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: