MEDICARE: MARK GUIMOND 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	0000037596	TN

General Provider Information

NPI Number	:	1649623638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK GUIMOND PHARMD

Provider Business Mailing Address
First Line	:	4729 N ROAN ST
Second Line	:	SUITE 2
City	:	JOHNSON CITY
State	:	TN
Zip	:	37615-3886
Country	:	US
Telephone Number	:	423-283-0911
Fax Number	:	423-283-0990

Provider Business Practice Location Address
First Line	:	4729 N ROAN ST
Second Line	:	SUITE 2
City	:	JOHNSON CITY
State	:	TN
Zip	:	37615-3886
Country	:	US
Telephone Number	:	423-283-0911
Fax Number	:

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

Provider Enumeration Date	:	07/14/2016
Last Update Date	:	04/07/2023

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