Provider Demographics
NPI:1760992093
Name:LEWALLEN, NICHOLEAH JADE (PHARM D)
Entity Type:Individual
Prefix:
First Name:NICHOLEAH
Middle Name:JADE
Last Name:LEWALLEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:NICHOLEAH
Other - Middle Name:JADE
Other - Last Name:LEWALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NICHOLEAH LAY
Mailing Address - Street 1:483 S LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-5813
Mailing Address - Country:US
Mailing Address - Phone:423-215-5449
Mailing Address - Fax:
Practice Address - Street 1:1901 W CLINCH AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2307
Practice Address - Country:US
Practice Address - Phone:865-331-1533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist