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General NPI Number Information
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NPI Number | 1891837654
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Entity Type | Organization
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Legal Business Name | JOHN E MOTHERAL
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 01/09/2019
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Provider Practice Location Address
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Address Line | 2340 CEDAR ST
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City | MC KENZIE
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State | TN
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Zip | 38201-2249
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Country | US
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Telephone | 731-352-3242
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Fax | 731-352-5860
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Provider Business Mailing Address
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Address Line | 2340 CEDAR ST
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City | MC KENZIE
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State | TN
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Zip | 38201-2249
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Country | US
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Telephone | 731-352-3242
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Fax | 731-352-5860
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Authorized Official
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Title or Position | MANAGER
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Name | PAUL THOMAS MOTHERAL
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Credential | PHARMD
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Telephone | 731-352-3242
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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 | 0000637
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License Number State | TN
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