Healthcare Provider Details

I. General information

NPI: 1851482459
Provider Name (Legal Business Name): JEREMY PAUL MUZZALL PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/05/2021
Certification Date: 02/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6509 HIGHWAY 41A STE B
PLEASANT VIEW TN
37146-7171
US

IV. Provider business mailing address

5019 ALBRIGHT RD
CLARKSVILLE TN
37043-6914
US

V. Phone/Fax

Practice location:
  • Phone: 931-206-2975
  • Fax:
Mailing address:
  • Phone: 931-206-2975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number23908
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23908
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: