Healthcare Provider Details

I. General information

NPI: 1982903258
Provider Name (Legal Business Name): JOSE POLLY BOJOS CAJERAS PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 S LOWRY ST
SMYRNA TN
37167-3803
US

IV. Provider business mailing address

567 S LOWRY ST
SMYRNA TN
37167-3803
US

V. Phone/Fax

Practice location:
  • Phone: 615-459-7722
  • Fax: 615-459-3831
Mailing address:
  • Phone: 615-459-7722
  • Fax: 615-459-3831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33360
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: