Provider Demographics
NPI:1639772908
Name:AMMARELL, DAVID TYLER
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:TYLER
Last Name:AMMARELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4339 BELMONT PARK TER
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-3607
Mailing Address - Country:US
Mailing Address - Phone:615-504-6560
Mailing Address - Fax:
Practice Address - Street 1:1793 GALLATIN PIKE N
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2122
Practice Address - Country:US
Practice Address - Phone:615-868-4597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist