Treston Humphreys
Individual provider Active NPI Pharmacist · Hohenwald, TN
NPI 1982109583 · NPPES record last updated Mar 26, 2018
Key facts
- NPI
- 1982109583
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 39248 (TN)
- Practice address
- 612 E Main St
Hohenwald, TN 38462-2008 - Phone
- (931) 796-3284
- NPI assigned
- Mar 26, 2018
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 39248 | TN | MD | Electrodiagnostic Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East, LP | Past | Accepting new patients | |
| Wal-Mart Stores East LP | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 39248 | TN | Yes |
Addresses
Primary practice location
612 E Main St
Hohenwald, TN 38462-2008
Mailing address
612 E Main St
Hohenwald, TN 38462-2008
Phone (931) 796-3284
Other providers in Hohenwald, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2018. 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.