MEDICARE: RONALD TERRY LEVERETTE D. 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	183500000X	Pharmacist	5322	TN

General Provider Information

NPI Number	:	1447582614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD TERRY LEVERETTE D. PH.

Provider Business Mailing Address
First Line	:	1806 N JACKSON ST
Second Line	:
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-2202
Country	:	US
Telephone Number	:	931-455-1806
Fax Number	:	931-455-1305

Provider Business Practice Location Address
First Line	:	1806 N JACKSON ST
Second Line	:
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-2202
Country	:	US
Telephone Number	:	931-455-1806
Fax Number	:	931-455-1305

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

Provider Enumeration Date	:	02/12/2010
Last Update Date	:	02/12/2010

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