Provider Demographics
NPI:1801858220
Name:SKELTON, JAMES ANDREW SR (DPH)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANDREW
Last Name:SKELTON
Suffix:SR
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 1:940 SPANISH TRAIL LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-2845
Mailing Address - Country:US
Mailing Address - Phone:901-382-5519
Mailing Address - Fax:
Practice Address - Street 1:3545 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-1653
Practice Address - Country:US
Practice Address - Phone:901-363-9046
Practice Address - Fax:901-363-8694
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3753COtherBOARD OF PHARMACY