Healthcare Provider Details

I. General information

NPI: 1851733117
Provider Name (Legal Business Name): EMILY H KECKRITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 01/17/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 N JACKSON ST STE 500
TULLAHOMA TN
37388-2252
US

IV. Provider business mailing address

1905 N JACKSON ST STE 500
TULLAHOMA TN
37388-2252
US

V. Phone/Fax

Practice location:
  • Phone: 931-454-0482
  • Fax:
Mailing address:
  • Phone: 931-454-0482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9779
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: