Provider Demographics
NPI:1710343173
Name:ANDERS, JASON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:ANDERS
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 1:5201 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-2345
Mailing Address - Country:US
Mailing Address - Phone:865-686-1020
Mailing Address - Fax:
Practice Address - Street 1:1167 HIGHWAY 49 S
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218-4409
Practice Address - Country:US
Practice Address - Phone:601-664-0600
Practice Address - Fax:601-664-0602
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39664183500000X
MST-164331835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist