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General NPI Number Information
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NPI Number | 1760603005
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Entity Type | Organization
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Legal Business Name | STATE OF TENNESSEE
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 02/22/2018
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Provider Practice Location Address
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Address Line | 1100 ENGLAND DRIVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-0924
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Country | US
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Telephone | 931-646-7551
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Fax | 931-646-7596
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Provider Business Mailing Address
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Address Line | 1100 ENGLAND DRIVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-0924
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Country | US
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Telephone | 931-646-7551
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Fax | 931-646-7596
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Authorized Official
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Title or Position | REGIONAL PHARMACIST
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Name | TONYA G. STEPHENS
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Credential | PHARMACIST
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Telephone | 931-646-7551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 4908839
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License Number State | TN
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