Provider Demographics
NPI:1760979868
Name:BARNES, PAIGE (PHARMD)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 RED OAK RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37144-7817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1224 HUNTSVILLE HWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3618
Practice Address - Country:US
Practice Address - Phone:931-433-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18765183500000X
TN39130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL18765OtherSTATE LICENSE
TN39130OtherSTATE LICENSE