MEDICARE: TOTAL HEALTH

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	4232	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2094878	OTHER		PK

General Provider Information

NPI Number	:	1881609485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL HEALTH

Provider Business Mailing Address
First Line	:	7259 OAK RIDGE HWY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37931-2614
Country	:	US
Telephone Number	:	865-693-1025
Fax Number	:	865-691-7653

Provider Business Practice Location Address
First Line	:	7259 OAK RIDGE HWY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37931-2614
Country	:	US
Telephone Number	:	965-693-1025
Fax Number	:	865-691-7653

Authorized Official
Title or Position	:	PHARMACIST
Name	:	JERRY GORDAN
Credential	:	DPH
Telephone Number	:	865-693-1025

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	10/07/2014

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Directions to “TOTAL HEALTH ” Practice Location

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