Provider Demographics
NPI:1104341098
Name:HAROLD, ALYSSA LYNN (PHARM D)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LYNN
Last Name:HAROLD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-5320
Mailing Address - Country:US
Mailing Address - Phone:931-537-3850
Mailing Address - Fax:
Practice Address - Street 1:589 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-5320
Practice Address - Country:US
Practice Address - Phone:931-537-3850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41024183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist