Provider Demographics
NPI:1255818860
Name:GANNAWAY, CHESNEY (PHARMD)
Entity type:Individual
Prefix:
First Name:CHESNEY
Middle Name:
Last Name:GANNAWAY
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 1:113 HERITAGE CT
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-5878
Mailing Address - Country:US
Mailing Address - Phone:423-276-5220
Mailing Address - Fax:
Practice Address - Street 1:4470 N ROAN ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615-4922
Practice Address - Country:US
Practice Address - Phone:423-282-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist