MEDICARE: DR. LARA DENNISON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	138298	TN

General Provider Information

NPI Number	:	1225312556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARA DENNISON

Provider Business Mailing Address
First Line	:	7839 SCENIC VIEW DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37938-3238
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6702 CLINTON HWY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37912-1018
Country	:	US
Telephone Number	:	865-947-6892
Fax Number	:	865-938-9083

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2011
Last Update Date	:	08/05/2013

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