Provider Demographics
NPI:1477063287
Name:HARTLETT, JERI SUE
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:SUE
Last Name:HARTLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JERI
Other - Middle Name:SUE
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6350 W ANDREW JOHNSON HWY DEPT 100
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8605
Mailing Address - Country:US
Mailing Address - Phone:800-355-3565
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:2018 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-5718
Practice Address - Country:US
Practice Address - Phone:865-544-0406
Practice Address - Fax:865-544-0480
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21031183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician