MEDICARE: MR. JOEY G PRICHARD DPH

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	4065	TN

General Provider Information

NPI Number	:	1770517856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOEY G PRICHARD DPH

Provider Business Mailing Address
First Line	:	2456 BUCKINGHAM RD
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37745
Country	:	US
Telephone Number	:	423-638-2722
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 WEST CHURCH ST
Second Line	:	NORTHEAST REGIONAL PHARMACY EAST REGIONAL PHARMACY
City	:	GREENEVILLE
State	:	TN
Zip	:	37745-0159
Country	:	US
Telephone Number	:	423-798-1749
Fax Number	:	423-798-1755

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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