Basic Information
| Provider Information | |||||||||
| NPI: | 1801297791 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNIVERSITY OF TENN ATHLETIC DEPT. PHARMACY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1551 LAKE LOUDON BLVD | ||||||||
| Address2: | A107 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379164009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659741231 | ||||||||
| FaxNumber: | 8659741259 | ||||||||
| Practice Location | |||||||||
| Address1: | 1551 LAKE LOUDON BLVD | ||||||||
| Address2: | A107 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379164009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659741231 | ||||||||
| FaxNumber: | 8659741259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2014 | ||||||||
| LastUpdateDate: | 09/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | CHOLKA | ||||||||
| AuthorizedOfficialFirstName: | KERRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHARMACIST IN CHARGE | ||||||||
| AuthorizedOfficialTelephone: | 8659741231 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHARMD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | 318 | TN | Y | Suppliers | Pharmacy |
No ID Information.