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General NPI Number Information
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NPI Number | 1881282580
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Entity Type | Individual
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Provider Name | SHEA ALEXIS LONG
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Gender | Female
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Dates
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Enumeration Date | 01/07/2021
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 1800 VOLUNTEER BLVD
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City | KNOXVILLE
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State | TN
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Zip | 37996-4522
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Country | US
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Telephone | 865-974-5932
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Fax |
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Provider Business Mailing Address
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Address Line | 12026 SALT CREEK LN
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City | KNOXVILLE
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State | TN
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Zip | 37932-3487
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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 | 41641
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License Number State | TN
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