Alexa Noelle Dodson Bancroft
Individual provider Active NPI Pharmacist · Athens, TN
NPI 1700550753 · NPPES record last updated Aug 3, 2021
Key facts
- NPI
- 1700550753
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 45131 (TN)
- Practice address
- 1114 W Madison Ave
Athens, TN 37303-4150 - Phone
- (423) 745-1411
- NPI assigned
- Aug 3, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 45131 | TN | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 45131 | TN | Yes |
Addresses
Primary practice location
1114 W Madison Ave
Athens, TN 37303-4150
Mailing address
1114 Tomahawk Cir NW
Cleveland, TN 37312-3462
Phone (423) 284-9616
Other practice location 1
5301 Ringgold Rd
East Ridge, TN 37412-3125
Phone (423) 892-9559
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | N/A |
Other providers in Athens, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2021. 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.