Provider Demographics
NPI:1003269564
Name:MAYNARD, MEGANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MEGANN
Middle Name:
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4059
Mailing Address - Country:US
Mailing Address - Phone:931-484-4388
Mailing Address - Fax:931-456-5192
Practice Address - Street 1:1106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4059
Practice Address - Country:US
Practice Address - Phone:931-484-4388
Practice Address - Fax:931-456-5192
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist