Provider Demographics
NPI:1558881599
Name:FUTCH, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:FUTCH
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 1:9115 AUSTIN LN
Mailing Address - Street 2:
Mailing Address - City:LYLES
Mailing Address - State:TN
Mailing Address - Zip Code:37098-1584
Mailing Address - Country:US
Mailing Address - Phone:615-351-0062
Mailing Address - Fax:
Practice Address - Street 1:318 E COLLEGE ST STE 102
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1832
Practice Address - Country:US
Practice Address - Phone:615-682-8472
Practice Address - Fax:615-988-6970
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN249821835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000OtherNONE