Grant Wallen, PHARMD
Individual provider Active NPI Pharmacist · Strawberry Plains, TN
NPI 1396567046 · NPPES record last updated Oct 24, 2024
Key facts
- NPI
- 1396567046
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 48112 (TN)
- Practice address
- 524 Andrew Johnson Highway
Strawberry Plains, TN 37871 - Phone
- (865) 933-4149
- Fax
- (865) 933-4037
- NPI assigned
- Oct 24, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48112 | TN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| East Tennessee Medical Services LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 48112 | TN | Yes |
Addresses
Primary practice location
524 Andrew Johnson Highway
Strawberry Plains, TN 37871
Mailing address
1270 Meadowlands CR
Sevierville, TN 37876
Phone (865) 253-2769
Other providers in Strawberry Plains, TN
- Alyssa Rose Park
- Paige Rayfield
- Deidra Rose Rudder
- Megan Leann Shiverdecker
- Kelly D Sikes
- Sara Bertha Williar
All providers in Strawberry Plains, TN · Pharmacist in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.