Active NPI
Thomas Derrick Gardner, R,PH
- Pharmacist
- Hixson, TN
National Provider Identifier
1487852430
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 1278
- Practice address
- 4018 Breakwater Dr
Hixson, TN 37343-3528 - Phone
- (423) 842-2173
- NPI assigned
- Jul 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 1278 | TN | Primary |
Addresses
Primary practice location
4018 Breakwater Dr
Hixson, TN 37343-3528
Mailing address
4018 Breakwater Dr
Hixson, TN 37343-3528
Phone (423) 842-2173
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1278 | Other | TN | STATE LICENSE |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1278 | TN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184025600000",
"number": "1487852430",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4018 BREAKWATER DR",
"city": "HIXSON",
"state": "TN",
"postal_code": "373433528",
"telephone_number": "423-842-2173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4018 BREAKWATER DR",
"city": "HIXSON",
"state": "TN",
"postal_code": "373433528",
"telephone_number": "423-842-2173"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "THOMAS",
"middle_name": "DERRICK",
"credential": "R,PH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-10",
"last_updated": "2007-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "1278",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "1278",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hixson, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.