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General NPI Number Information
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NPI Number | 1801560974
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Entity Type | Individual
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Provider Name | MARIAH ANN HUSKEY
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Gender | Female
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Dates
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Enumeration Date | 08/03/2021
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | DOGWOOD AVE BUILDING 8
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City | MOUNTAIN HOME
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State | TN
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Zip | 37604
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Country | US
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Telephone | 423-926-1171
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Fax |
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Provider Business Mailing Address
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Address Line | 2258 FOREST ACRES DR
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City | JOHNSON CITY
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State | TN
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Zip | 37604-7172
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Country | US
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Telephone | 865-322-1212
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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 | 45172
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License Number State | TN
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