Healthcare Provider Details

I. General information

NPI: 1639410004
Provider Name (Legal Business Name): JENNIFER SORAH TROTTER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 CAMPUS DR STE 200
ABINGDON VA
24210-9703
US

IV. Provider business mailing address

122 MAXWELL DR
BRISTOL TN
37620-2926
US

V. Phone/Fax

Practice location:
  • Phone: 276-628-1186
  • Fax: 276-628-8507
Mailing address:
  • Phone: 423-534-6283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number36819
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: