Individual
JACOB ALEXANDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5588 LITTLE DEBBIE PKWY, OOLTEWAH, TN 37363-4356
(423) 238-1059
Mailing address
5588 LITTLE DEBBIE PKWY, OOLTEWAH, TN 37363-4356
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
041608
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041608
STATE PHARMACY LICENSE
TN
Enumeration date
02/16/2018
Last updated
02/16/2018
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