Basic Information
| Provider Information | |||||||||
| NPI: | 1225536345 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHILDS | ||||||||
| FirstName: | MARVIN | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | PHARM D | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4331 W ANDREW JOHNSON HWY | ||||||||
| Address2: | |||||||||
| City: | MORRISTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378141036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232546672 | ||||||||
| FaxNumber: | 4232546674 | ||||||||
| Practice Location | |||||||||
| Address1: | 4331 W ANDREW JOHNSON HWY | ||||||||
| Address2: | |||||||||
| City: | MORRISTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378141036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232546672 | ||||||||
| FaxNumber: | 4232546674 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2018 | ||||||||
| LastUpdateDate: | 01/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 36668 | TN | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.