Provider Demographics
NPI:1912336868
Name:SKELTON, WESLEY BLAKE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:BLAKE
Last Name:SKELTON
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 1:4976 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5470
Mailing Address - Country:US
Mailing Address - Phone:423-497-5355
Mailing Address - Fax:423-309-0281
Practice Address - Street 1:4972 ALPHA LANE
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5470
Practice Address - Country:US
Practice Address - Phone:423-497-5360
Practice Address - Fax:423-305-7269
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist