MEDICARE: DR. JACQUALYN DEAL 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	36809	TN

General Provider Information

NPI Number	:	1578901757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUALYN DEAL PHARMD

Provider Business Mailing Address
First Line	:	210 FRANKLIN RD
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-3218
Country	:	US
Telephone Number	:	615-373-8957
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 FRANKLIN RD
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-3218
Country	:	US
Telephone Number	:	615-373-8957
Fax Number	:

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

Provider Enumeration Date	:	06/10/2013
Last Update Date	:	06/10/2013

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