Provider Demographics
NPI:1700997020
Name:STEWART, JIMMIE BOYD (RPH)
Entity Type:Individual
Prefix:
First Name:JIMMIE
Middle Name:BOYD
Last Name:STEWART
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 TEDLO LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-5270
Mailing Address - Country:US
Mailing Address - Phone:865-577-3641
Mailing Address - Fax:865-577-8248
Practice Address - Street 1:229 FORKS OF THE RIVER PKWY
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3418
Practice Address - Country:US
Practice Address - Phone:865-453-7121
Practice Address - Fax:865-428-1804
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist