Provider Demographics
NPI:1659320687
Name:CROSS, STEPHANIE SIMS (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SIMS
Last Name:CROSS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 SEDGLEY DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-4363
Mailing Address - Country:US
Mailing Address - Phone:865-456-7676
Mailing Address - Fax:
Practice Address - Street 1:8848 CEDAR SPRINGS LN STE 100
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5414
Practice Address - Country:US
Practice Address - Phone:865-769-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist