Provider Demographics
NPI:1396817508
Name:LAYNE, EMILY PITTMAN (BS)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:PITTMAN
Last Name:LAYNE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 S CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PITTSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37380-1305
Mailing Address - Country:US
Mailing Address - Phone:423-837-6855
Mailing Address - Fax:423-837-1420
Practice Address - Street 1:335 S CEDAR AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PITTSBURG
Practice Address - State:TN
Practice Address - Zip Code:37380-1305
Practice Address - Country:US
Practice Address - Phone:423-837-6855
Practice Address - Fax:423-837-1420
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist