Provider Demographics
NPI:1134237555
Name:RATHJEN, MARK DOUGLAS (PHARMD RPH DPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:DOUGLAS
Last Name:RATHJEN
Suffix:
Gender:M
Credentials:PHARMD RPH DPH
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8621 DOLPH DRIVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-2406
Mailing Address - Country:US
Mailing Address - Phone:865-531-1076
Mailing Address - Fax:865-769-8656
Practice Address - Street 1:7466 OAK RIDGE HWY
Practice Address - Street 2:INGLES PHARMACY #304
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931
Practice Address - Country:US
Practice Address - Phone:865-769-8326
Practice Address - Fax:865-769-8656
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6283183500000X
TN8017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist