Provider Demographics
NPI:1770863698
Name:SWALLOWS, JEREMY (DPH)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:SWALLOWS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 INVERNESS DR NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-2240
Mailing Address - Country:US
Mailing Address - Phone:423-650-9307
Mailing Address - Fax:
Practice Address - Street 1:116 WHITE WATER DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:TN
Practice Address - Zip Code:37361-3644
Practice Address - Country:US
Practice Address - Phone:423-216-0050
Practice Address - Fax:423-216-0053
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist