Provider Demographics
NPI:1851662100
Name:BARHAM, JONATHAN EDWIN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:EDWIN
Last Name:BARHAM
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 1:245 INDIAN LAKE BLVD
Mailing Address - Street 2:APT J107
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-6273
Mailing Address - Country:US
Mailing Address - Phone:870-403-8798
Mailing Address - Fax:
Practice Address - Street 1:2780 WILMA RUDOLPH BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5897
Practice Address - Country:US
Practice Address - Phone:931-552-0908
Practice Address - Fax:931-645-3167
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist