Healthcare Provider Details

I. General information

NPI: 1285706465
Provider Name (Legal Business Name): JEREMY G YORK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 S CEDAR AVE
SOUTH PITTSBURG TN
37380-1305
US

IV. Provider business mailing address

335 S CEDAR AVE
SOUTH PITTSBURG TN
37380-1305
US

V. Phone/Fax

Practice location:
  • Phone: 423-837-6855
  • Fax: 423-837-1420
Mailing address:
  • Phone: 423-837-6855
  • Fax: 423-837-1420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11819
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: