Provider Demographics
NPI:1619527934
Name:CROSS, DAVID LYNN (DPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LYNN
Last Name:CROSS
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 1:19740 ALBERTA ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-3305
Mailing Address - Country:US
Mailing Address - Phone:423-569-6633
Mailing Address - Fax:423-569-6932
Practice Address - Street 1:19740 ALBERTA ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-3305
Practice Address - Country:US
Practice Address - Phone:423-569-6633
Practice Address - Fax:423-569-6932
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist