Provider Demographics
NPI:1891080677
Name:PATTESON, JENNA (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:
Last Name:PATTESON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 WASHINGTON PIKE
Mailing Address - Street 2:TARGET PHARMACY T 2057
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-7004
Mailing Address - Country:US
Mailing Address - Phone:865-291-0087
Mailing Address - Fax:865-291-0087
Practice Address - Street 1:5405 WASHINGTON PIKE
Practice Address - Street 2:TARGET PHARMACY T 2057
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-7004
Practice Address - Country:US
Practice Address - Phone:865-291-0087
Practice Address - Fax:865-291-0087
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33643183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist