Provider Demographics
NPI:1215525241
Name:RYAN, JILL JUSTICE (PHARMD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:JUSTICE
Last Name:RYAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:RENEE
Other - Last Name:JUSTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:931 CHANNEL VIEW LN
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-5613
Mailing Address - Country:US
Mailing Address - Phone:423-875-2264
Mailing Address - Fax:
Practice Address - Street 1:931 CHANNEL VIEW LN
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-5613
Practice Address - Country:US
Practice Address - Phone:423-875-2264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist