Provider Demographics
NPI:1639211667
Name:LOTT, BEN CRAWFORD (DPH)
Entity Type:Individual
Prefix:MR
First Name:BEN
Middle Name:CRAWFORD
Last Name:LOTT
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 1:5917 WESTMERE DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1052
Mailing Address - Country:US
Mailing Address - Phone:865-470-7934
Mailing Address - Fax:
Practice Address - Street 1:8727-A ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37924
Practice Address - Country:US
Practice Address - Phone:865-933-2451
Practice Address - Fax:865-932-1838
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3562149Medicaid
TN3562149Medicaid
TN1172760001Medicare NSC