Individual
EMILY PROVENCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
139 WESLEY REED DR, SUITE F, ATOKA, TN 38004-4905
(901) 837-8801
Mailing address
8015 SODERLUND DR, MILLINGTON, TN 38053-5826
(901) 489-3582
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
6131
TN
Other
Enumeration date
06/10/2016
Last updated
06/10/2016
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