Provider Demographics
NPI:1982989224
Name:VICARS, MARY KELLY (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KELLY
Last Name:VICARS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 MIDDLEBROOK PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-4701
Mailing Address - Country:US
Mailing Address - Phone:865-531-0033
Mailing Address - Fax:865-531-0115
Practice Address - Street 1:9200 MIDDLEBROOK PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-4701
Practice Address - Country:US
Practice Address - Phone:865-531-0033
Practice Address - Fax:865-531-0115
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist