Provider Demographics
NPI:1548606312
Name:ABBOTT, EMILY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:ABBOTT
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 1:2207 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-3078
Mailing Address - Country:US
Mailing Address - Phone:877-220-6337
Mailing Address - Fax:888-908-0198
Practice Address - Street 1:104 HUDSON ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-4608
Practice Address - Country:US
Practice Address - Phone:865-414-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11673183500000X
MD21077183500000X
LA020039183500000X
ARPD11872183500000X
NE14032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist