Provider Demographics
NPI:1124056973
Name:VANNOY, MARTY BAKER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARTY
Middle Name:BAKER
Last Name:VANNOY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MARTY
Other - Middle Name:ANDREA
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:162 MOUNTAIN RIDGES DR
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-6382
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:JAMES H. QUILLEN/VA MEDICAL CENTER
Practice Address - Street 2:CORNER OF SIDNEY AND LAMONT
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-3435
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN121811835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy