Provider Demographics
NPI:1871827600
Name:PEARSALL, NANCY BROOME (DPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:BROOME
Last Name:PEARSALL
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7325 CROWN RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-8305
Mailing Address - Country:US
Mailing Address - Phone:865-922-9068
Mailing Address - Fax:865-925-0694
Practice Address - Street 1:7325 CROWN RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-8305
Practice Address - Country:US
Practice Address - Phone:865-922-9068
Practice Address - Fax:865-925-0694
Is Sole Proprietor?:No
Enumeration Date:2009-09-26
Last Update Date:2009-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist