Provider Demographics
NPI:1801297791
Name:UNIVERSITY OF TENN ATHLETIC DEPT. PHARMACY
Entity type:Organization
Organization Name:UNIVERSITY OF TENN ATHLETIC DEPT. PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOLKA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:865-974-1231
Mailing Address - Street 1:1551 LAKE LOUDON BLVD
Mailing Address - Street 2:A107
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-4009
Mailing Address - Country:US
Mailing Address - Phone:865-974-1231
Mailing Address - Fax:865-974-1259
Practice Address - Street 1:1551 LAKE LOUDON BLVD
Practice Address - Street 2:A107
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-4009
Practice Address - Country:US
Practice Address - Phone:865-974-1231
Practice Address - Fax:865-974-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN318333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy