Russell B Mantooth, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

8467 Issued in TN

Practice address

420 Woodway Dr
Blountville, TN 37617-5558

Phone

(423) 323-3047

Fax

(423) 542-1220

NPI assigned

Oct 12, 2006

Last updated

Jul 25, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185321600000",
    "number": "1053400374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 WOODWAY DR",
            "city": "BLOUNTVILLE",
            "state": "TN",
            "postal_code": "376175558",
            "telephone_number": "423-323-3047",
            "fax_number": "423-542-1220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 WOODWAY DR",
            "city": "BLOUNTVILLE",
            "state": "TN",
            "postal_code": "376175558",
            "telephone_number": "423-323-3047",
            "fax_number": "423-542-1220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTOOTH",
        "first_name": "RUSSELL",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TN",
            "license": "8467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela Denise Lewis, LPN
• Tanya Rae Light, BSN RN
• Sarah E Linnane, CPM, CPM-TN
• Chelsea Paige Long, REGISTERED NURSE
• Autumn Samantha Longworth, CRNA
• Mark a. Bowers (Blountville Family Eyecare)
• Everett Ellison McDuffie, M.D.
• Heather Leann McElyea
• Kelly McKaig
• Medexpress Urgent Care, PC - Virginia (MedExpress Urgent Care - Nick Patel, M.D.)

• Pharmacist in Blountville, TN
• Providers in Blountville, TN by specialty
• Pharmacist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.