MEDICARE: MR. SHAWN LOCKERT R.PH.

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	7056	TN

General Provider Information

NPI Number	:	1992883433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAWN LOCKERT R.PH.

Provider Business Mailing Address
First Line	:	3836 GOOSENECK DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-6185
Country	:	US
Telephone Number	:	865-573-7947
Fax Number	:	865-681-8226

Provider Business Practice Location Address
First Line	:	131 MONTGOMERY LN
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37803-5649
Country	:	US
Telephone Number	:	865-681-0520
Fax Number	:	865-681-8226

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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