Provider Demographics
NPI:1700171253
Name:WEIKLE-WADDELL, JOYCE (PHARM-D)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:
Last Name:WEIKLE-WADDELL
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:MS
Other - First Name:JOY
Other - Middle Name:
Other - Last Name:WADDELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM-D
Mailing Address - Street 1:267 OVERHILL DR
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-4349
Mailing Address - Country:US
Mailing Address - Phone:423-913-2764
Mailing Address - Fax:
Practice Address - Street 1:401A ELM ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4601
Practice Address - Country:US
Practice Address - Phone:423-431-1570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN033348183500000X
WVRP0006476183500000X
VA0202205977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist