MEDICARE: JOANNAH DERRICK

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	39553	TN

General Provider Information

NPI Number	:	1700482817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNAH DERRICK

Provider Business Mailing Address
First Line	:	2500 LEBANON PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37214-2415
Country	:	US
Telephone Number	:	615-889-6300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 LEBANON PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37214-2415
Country	:	US
Telephone Number	:	615-889-6300
Fax Number	:

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

Provider Enumeration Date	:	12/05/2020
Last Update Date	:	12/05/2020

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Directions to “ JOANNAH DERRICK ” Practice Location

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