MEDICARE: MRS. JANET RANSOM DPH

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	19440	TN

General Provider Information

NPI Number	:	1285754192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANET RANSOM DPH

Provider Business Mailing Address
First Line	:	4508 JOHNSON ROAD
Second Line	:
City	:	BIRCHWOOD
State	:	TN
Zip	:	37308
Country	:	US
Telephone Number	:	423-961-0349
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 DESALES AVE
Second Line	:	MEMORIAL HOSPITAL
City	:	CHATTANOOGA
State	:	TN
Zip	:	37343
Country	:	US
Telephone Number	:	423-495-8380
Fax Number	:

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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