Healthcare Provider Details

I. General information

NPI: 1326499765
Provider Name (Legal Business Name): MINH HAI THI NGUYEN PELKEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N GATEWAY AVE
ROCKWOOD TN
37854-2330
US

IV. Provider business mailing address

103 N GATEWAY AVE
ROCKWOOD TN
37854-2330
US

V. Phone/Fax

Practice location:
  • Phone: 865-354-3522
  • Fax: 865-354-8381
Mailing address:
  • Phone: 865-354-3522
  • Fax: 865-354-8381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number39797
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number018153
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: