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General NPI Number Information
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NPI Number | 1881427110
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Entity Type | Individual
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Provider Name | JUSTIN ANDREW WOMACK PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/22/2024
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 1771 MADISON ST
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City | CLARKSVILLE
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State | TN
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Zip | 37043-4990
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Country | US
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Telephone | 931-551-7031
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Fax |
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Provider Business Mailing Address
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Address Line | 2685 ELMO RD
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City | PEMBROKE
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State | KY
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Zip | 42266-9741
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Country | US
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Telephone | 270-484-0285
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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 | 48391
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License Number State | TN
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