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General NPI Number Information
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NPI Number | 1932764941
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Entity Type | Organization
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Legal Business Name | TAKE CHARGE NUTRITION, LLC
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 1690 25TH ST NW STE D
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City | CLEVELAND
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State | TN
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Zip | 37311-3613
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Country | US
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Telephone | 800-782-3444
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Fax |
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Provider Business Mailing Address
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Address Line | 7206 DALTON PIKE SE
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City | CLEVELAND
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State | TN
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Zip | 37323-9124
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Country | US
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Telephone | 423-284-9478
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Fax | 423-559-3011
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DAVID TERRY FORSHEE
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Credential | RPH
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Telephone | 800-782-3444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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