Provider Demographics
NPI:1366918120
Name:JEWELL, TBONY MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TBONY
Middle Name:MARIE
Last Name:JEWELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 ASHLAND CITY RD APT 1621
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5294
Mailing Address - Country:US
Mailing Address - Phone:614-359-3745
Mailing Address - Fax:
Practice Address - Street 1:588 FIRE STATION RD STE F
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4091
Practice Address - Country:US
Practice Address - Phone:614-359-3745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN41653OtherSTATE PHARMACIST LICENSE