Provider Demographics
NPI:1376837617
Name:CRAIN, JEREMY M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:M
Last Name:CRAIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5544 OLD HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2576
Mailing Address - Country:US
Mailing Address - Phone:615-584-3891
Mailing Address - Fax:615-883-9226
Practice Address - Street 1:5544 OLD HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2576
Practice Address - Country:US
Practice Address - Phone:615-584-3891
Practice Address - Fax:615-883-9226
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist