Provider Demographics
NPI:1073012852
Name:MAYFIELD, PATTI CARLENE (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:PATTI
Middle Name:CARLENE
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16773 RANKIN AVE
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:TN
Mailing Address - Zip Code:37327-7021
Mailing Address - Country:US
Mailing Address - Phone:423-949-5056
Mailing Address - Fax:423-949-2448
Practice Address - Street 1:16773 RANKIN AVE
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327-7021
Practice Address - Country:US
Practice Address - Phone:423-949-5056
Practice Address - Fax:423-949-2448
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist