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General NPI Number Information
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NPI Number | 1134237555
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Entity Type | Individual
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Provider Name | MARK DOUGLAS RATHJEN PHARMD RPH DPH
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Gender | Male
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Dates
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Enumeration Date | 08/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7466 OAK RIDGE HWY INGLES PHARMACY #304
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City | KNOXVILLE
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State | TN
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Zip | 37931
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Country | US
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Telephone | 865-769-8326
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Fax | 865-769-8656
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Provider Business Mailing Address
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Address Line | 8621 DOLPH DRIVE
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City | KNOXVILLE
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State | TN
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Zip | 37931-2406
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Country | US
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Telephone | 865-531-1076
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Fax | 865-769-8656
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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 | 6283
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 8017
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License Number State | TN
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