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General NPI Number Information
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NPI Number | 1851678833
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Entity Type | Individual
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Provider Name | JOSEPH KYLE MAHAFFEY PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/04/2011
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Last Update Date | 11/04/2011
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Provider Practice Location Address
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Address Line | 35 25TH ST NW
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City | CLEVELAND
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State | TN
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Zip | 37311-3830
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Country | US
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Telephone | 423-614-4810
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Fax |
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Provider Business Mailing Address
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Address Line | 8309 FRONT GATE CIR
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City | OOLTEWAH
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State | TN
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Zip | 37363-9507
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Country | US
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Telephone | 423-605-9690
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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 | 0000033565
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License Number State | TN
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