MEDICARE: DAVID RODAMAKER PHARMD.

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	45216	TN

General Provider Information

NPI Number	:	1558932509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID RODAMAKER PHARMD.

Provider Business Mailing Address
First Line	:	120 NORWICH CV
Second Line	:
City	:	MEDINA
State	:	TN
Zip	:	38355-6869
Country	:	US
Telephone Number	:	731-487-9596
Fax Number	:

Provider Business Practice Location Address
First Line	:	1332 N HIGHLAND AVE
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38301-4019
Country	:	US
Telephone Number	:	731-427-4992
Fax Number	:

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

Provider Enumeration Date	:	07/09/2021
Last Update Date	:	07/09/2021

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