Provider Demographics
NPI:1477806966
Name:MAKIN, JAMES B (DPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:B
Last Name:MAKIN
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 S ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6221
Mailing Address - Country:US
Mailing Address - Phone:865-483-7164
Mailing Address - Fax:865-482-1414
Practice Address - Street 1:370 S ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6221
Practice Address - Country:US
Practice Address - Phone:865-483-7164
Practice Address - Fax:865-482-1414
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-21
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist