Provider Demographics
NPI:1518391101
Name:GAGNE, HOLLIE JOHNSON (PHARMD)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:JOHNSON
Last Name:GAGNE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 BLUFF CITY HWY
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-4602
Mailing Address - Country:US
Mailing Address - Phone:423-764-4136
Mailing Address - Fax:423-764-5167
Practice Address - Street 1:310 BLUFF CITY HWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-4602
Practice Address - Country:US
Practice Address - Phone:423-764-4136
Practice Address - Fax:423-764-5167
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist