Provider Demographics
NPI:1629312384
Name:BROXTON, JUSTIN WAYNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:WAYNE
Last Name:BROXTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9086 ROBERT GARLAND VW
Mailing Address - Street 2:
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379-8979
Mailing Address - Country:US
Mailing Address - Phone:423-504-0690
Mailing Address - Fax:
Practice Address - Street 1:9086 ROBERT GARLAND VW
Practice Address - Street 2:
Practice Address - City:SODDY DAISY
Practice Address - State:TN
Practice Address - Zip Code:37379-8979
Practice Address - Country:US
Practice Address - Phone:423-504-0690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26936183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist