Individual
JESSICA BROOKE BOULDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
483 W BOCKMAN WAY, SPARTA, TN 38583-1832
(931) 836-3230
Mailing address
48 GOLF CLUB RD, MCMINNVILLE, TN 37110-7838
(931) 314-0478
Taxonomy
Speciality
Code
Description
License number
State
1835P2201X
Ambulatory Care Pharmacist
Primary
44395
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44395
STATE OF TENNESSEE
TN
Enumeration date
01/20/2021
Last updated
01/20/2021
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