Provider Demographics
NPI:1770586901
Name:POWELL, DAVID WILSON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILSON
Last Name:POWELL
Suffix:
Gender:M
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:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:WHITE BLUFF
Mailing Address - State:TN
Mailing Address - Zip Code:37187-0640
Mailing Address - Country:US
Mailing Address - Phone:615-797-3343
Mailing Address - Fax:615-797-5250
Practice Address - Street 1:4514 HWY 70 E
Practice Address - Street 2:
Practice Address - City:WHITE BLUFF
Practice Address - State:TN
Practice Address - Zip Code:37187-0640
Practice Address - Country:US
Practice Address - Phone:615-797-3343
Practice Address - Fax:615-797-5250
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4415039OtherNABP NUMBER
TN4662110001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER