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General NPI Number Information
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NPI Number | 1457243685
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Entity Type | Individual
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Provider Name | ROSA O OCTOBRE
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Gender | Female
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 920 N STATE OF FRANKLIN RD
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City | JOHNSON CITY
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State | TN
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Zip | 37604-3668
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Country | US
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Telephone | 423-928-2661
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Fax |
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Provider Business Mailing Address
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Address Line | 509 PINE RIDGE RD
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City | JOHNSON CITY
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State | TN
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Zip | 37601-1849
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Country | US
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Telephone | 423-676-1294
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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 | 48933
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License Number State | TN
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