Provider Demographics
NPI:1326323957
Name:CANNON, SUSAN L (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:CANNON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8304 PEDIGO RD
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-2913
Mailing Address - Country:US
Mailing Address - Phone:865-922-6437
Mailing Address - Fax:865-922-5496
Practice Address - Street 1:6920 MAYNARDVILLE HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-5300
Practice Address - Country:US
Practice Address - Phone:865-922-6437
Practice Address - Fax:865-922-5494
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist