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General NPI Number Information
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NPI Number | 1588670319
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Entity Type | Organization
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Legal Business Name | JEFFREY ALLAN ANDERSON
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 725 TENNESSEE AVE
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City | ETOWAH
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State | TN
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Zip | 37331-1305
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Country | US
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Telephone | 423-263-7824
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Fax | 423-263-5714
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Provider Business Mailing Address
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Address Line | PO BOX 368 725 TENNESSEE AVE.
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City | ETOWAH
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State | TN
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Zip | 37331-0368
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Country | US
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Telephone | 423-263-7824
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Fax | 423-263-5714
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Authorized Official
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Title or Position | OWNER
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Name | MR. JEFFREY ALLAN ANDERSON
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Credential | PHARMACIST
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Telephone | 423-263-7824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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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 | 6691
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License Number State | TN
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