MEDICARE: DR. DAVID WILSON POWELL 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	3283	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4415039	OTHER	TN	NABP NUMBER

General Provider Information

NPI Number	:	1770586901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID WILSON POWELL PHARMD

Provider Business Mailing Address
First Line	:	PO BOX 640
Second Line	:
City	:	WHITE BLUFF
State	:	TN
Zip	:	37187-0640
Country	:	US
Telephone Number	:	615-797-3343
Fax Number	:	615-797-5250

Provider Business Practice Location Address
First Line	:	4514 HWY 70 E
Second Line	:
City	:	WHITE BLUFF
State	:	TN
Zip	:	37187-0640
Country	:	US
Telephone Number	:	615-797-3343
Fax Number	:	615-797-5250

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/16/2007

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