Active NPI
Pavel Petrushenko
- Pharmacist
- Farragut, TN
National Provider Identifier
1154932010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 39648
- Practice address
- 11927 Kingston Pike
Farragut, TN 37934-4602 - Phone
- (865) 671-0932
- Fax
- (865) 671-0964
- NPI assigned
- Aug 13, 2020
- Last updated
- Aug 13, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 39648 | TN | Primary |
Addresses
Primary practice location
11927 Kingston Pike
Farragut, TN 37934-4602
Mailing address
1260 Queenstown Way Apt 103
Knoxville, TN 37932-3183
Phone (814) 722-5475
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
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": []
}Other providers in Farragut, TN
Sources for this page
- 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.