Provider Demographics
NPI:1033190756
Name:PETTIS, EMILY MORGAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:MORGAN
Last Name:PETTIS
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 1:2336 SETTLERS RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-5931
Mailing Address - Country:US
Mailing Address - Phone:865-670-1578
Mailing Address - Fax:
Practice Address - Street 1:250 MIDDLE CREEK RD
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3944
Practice Address - Country:US
Practice Address - Phone:865-453-5160
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21928183500000X
GA22062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist