Pavel Petrushenko

Primary specialty

PharmacistTaxonomy code 183500000X

License

39648 Issued in TN

Practice address

11927 Kingston Pike
Farragut, TN 37934-4602

Phone

(865) 671-0932

Fax

(865) 671-0964

NPI assigned

Aug 13, 2020

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Walgreen Co

  • Pharmacy
  • Knoxville, TN
  • NPI 1720095730
  NPD (past)
• Walgreen Co

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

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

{
    "created_epoch": "1597276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597276800000",
    "number": "1154932010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 QUEENSTOWN WAY APT 103",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379323183",
            "telephone_number": "814-722-5475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11927 KINGSTON PIKE",
            "city": "FARRAGUT",
            "state": "TN",
            "postal_code": "379344602",
            "telephone_number": "865-671-0932",
            "fax_number": "865-671-0964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUSHENKO",
        "first_name": "PAVEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-13",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TN",
            "license": "39648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• National Neuro, LLC
• Nourish Physio and Yoga LLC
• Pamela G Ollard, PT
• Atit Uttambhai Patel
• Mark Peacock, DO
• Larry A Prislavsky, RPT
• PT Solutions LLC
• Publix Tennessee, LLC
• Wendy Erica Pullen, PTA
• Taraneh Rahmanian, PRH

• All providers in Farragut, TN
• Pharmacist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2020; 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.