Provider Demographics
NPI:1508180670
Name:SWANN, JOHNNY (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:
Last Name:SWANN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 DAYTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-2715
Mailing Address - Country:US
Mailing Address - Phone:423-877-9516
Mailing Address - Fax:423-877-9459
Practice Address - Street 1:3901 DAYTON BLVD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-2715
Practice Address - Country:US
Practice Address - Phone:423-877-9516
Practice Address - Fax:423-877-9459
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5760183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist