1851482459 NPI number — DR. JEREMY PAUL MUZZALL PHARM D.

Table of content: (NPI 1801692090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851482459 NPI number — DR. JEREMY PAUL MUZZALL PHARM D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUZZALL
Provider First Name:
JEREMY
Provider Middle Name:
PAUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851482459
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5019 ALBRIGHT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37043-6914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-206-2975
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6509 HIGHWAY 41A STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLEASANT VIEW
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37146-7171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-206-2975
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P1200X , with the licence number:  23908 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 23908 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)