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General NPI Number Information
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NPI Number | 1063797868
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Entity Type | Individual
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Provider Name | JEREMY RYAN FELKER PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/13/2011
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 100 NORTHCREST DR
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City | SPRINGFIELD
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State | TN
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Zip | 37172-3927
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Country | US
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Telephone | 615-384-1523
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Fax |
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Provider Business Mailing Address
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Address Line | 4383 OREGON RD
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City | SPRINGFIELD
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State | TN
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Zip | 37172-6409
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Country | US
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Telephone | 615-503-0772
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 33672
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License Number State | TN
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