MEDICARE: HENRY LARKIN WRIGHT R.PH.

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	1835N1003X	Nutrition Support Pharmacist	5776	TN

General Provider Information

NPI Number	:	1427170232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY LARKIN WRIGHT R.PH.

Provider Business Mailing Address
First Line	:	5214 VILLAGE CREST WAY
Second Line	:	APT. 125
City	:	KNOXVILLE
State	:	TN
Zip	:	37924-5005
Country	:	US
Telephone Number	:	865-363-9388
Fax Number	:

Provider Business Practice Location Address
First Line	:	5214 VILLAGE CREST WAY
Second Line	:	APT. 125
City	:	KNOXVILLE
State	:	TN
Zip	:	37924-5005
Country	:	US
Telephone Number	:	865-363-9366
Fax Number	:

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

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

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