Healthcare Provider Details

I. General information

NPI: 1740068972
Provider Name (Legal Business Name): MCKENZIE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11305 CHAPMAN HWY
SEYMOUR TN
37865-4811
US

IV. Provider business mailing address

1544 BARLEY CIR
KNOXVILLE TN
37922-5962
US

V. Phone/Fax

Practice location:
  • Phone: 865-579-3141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number47639
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number47369
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: