Healthcare Provider Details

I. General information

NPI: 1851678155
Provider Name (Legal Business Name): JOHN T. HEATHERLY III PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 FORKS OF THE RIVER PKWY
SEVIERVILLE TN
37862-3435
US

IV. Provider business mailing address

370 ELKINS RD
JACKSBORO TN
37757-2418
US

V. Phone/Fax

Practice location:
  • Phone: 865-908-8755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12839
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: