Provider Demographics
NPI:1396323820
Name:MEJIA, MARIA ELENA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:MEJIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 FORD RD
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5770
Mailing Address - Country:US
Mailing Address - Phone:865-229-1004
Mailing Address - Fax:
Practice Address - Street 1:911 HIGHWAY 321 N
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-6409
Practice Address - Country:US
Practice Address - Phone:865-986-9002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44039OtherPHARMACIST LICENSE
TN099049944OtherDRIVERS LICENSE