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General NPI Number Information
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NPI Number | 1336637941
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Entity Type | Individual
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Provider Name | TYLER DAVIS PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 6777 CLINTON HWY
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City | KNOXVILLE
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State | TN
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Zip | 37912-1020
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Country | US
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Telephone | 865-938-6706
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Fax |
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Provider Business Mailing Address
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Address Line | 200 MARINA DR
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City | CLINTON
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State | TN
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Zip | 37716-5980
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Country | US
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Telephone | 865-556-1332
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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 | 40662
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License Number State | TN
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