Healthcare Provider Details

I. General information

NPI: 1437748746
Provider Name (Legal Business Name): ANDREW TYLER JUSTICE PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 MIDDLE CREEK RD STE 1
SEVIERVILLE TN
37862-6921
US

IV. Provider business mailing address

1024 MIDDLE CREEK RD STE 1
SEVIERVILLE TN
37862-6921
US

V. Phone/Fax

Practice location:
  • Phone: 865-366-1770
  • Fax: 865-366-1771
Mailing address:
  • Phone: 865-366-1770
  • Fax: 865-366-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43281
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: