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General NPI Number Information
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NPI Number | 1770179038
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Entity Type | Individual
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Provider Name | TOM B GEOGHAGAN II
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Gender | Male
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Dates
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Enumeration Date | 12/21/2020
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Last Update Date | 12/21/2020
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Provider Practice Location Address
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Address Line | 284 MORRELL RD
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City | KNOXVILLE
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State | TN
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Zip | 37919-5876
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Country | US
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Telephone | 865-691-1153
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Fax |
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Provider Business Mailing Address
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Address Line | 6305 LONAS DR STE 201
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City | KNOXVILLE
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State | TN
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Zip | 37909-3203
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Country | US
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Telephone |
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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 | 10133
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License Number State | TN
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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 | RPH029044
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202212932
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 015986
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License Number State | KY
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