Provider Demographics
NPI:1992191357
Name:BOHANNON, JULIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BOHANNON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5032 OOLTEWAH RINGGOLD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-7091
Mailing Address - Country:US
Mailing Address - Phone:423-396-6963
Mailing Address - Fax:423-396-6947
Practice Address - Street 1:5032 OOLTEWAH RINGGOLD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-7091
Practice Address - Country:US
Practice Address - Phone:423-396-6963
Practice Address - Fax:423-396-6947
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist