Provider Demographics
NPI:1558340208
Name:CABBAGE, JILL SUSAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:SUSAN
Last Name:CABBAGE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:SUSAN
Other - Last Name:HODGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:452 DEER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37861-5225
Mailing Address - Country:US
Mailing Address - Phone:865-767-2877
Mailing Address - Fax:
Practice Address - Street 1:1901 W CLINCH AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2307
Practice Address - Country:US
Practice Address - Phone:865-541-3699
Practice Address - Fax:865-541-1786
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist