Provider Demographics
NPI:1528739067
Name:VAVRA, AMIE DAWN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMIE
Middle Name:DAWN
Last Name:VAVRA
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 1:1134 VIKING DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-2586
Mailing Address - Country:US
Mailing Address - Phone:224-629-3360
Mailing Address - Fax:
Practice Address - Street 1:1299 OAK RIDGE TPKE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6406
Practice Address - Country:US
Practice Address - Phone:865-482-4828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist