Provider Demographics
NPI:1699074815
Name:MARCHETTI, ANTONIO M (RPH)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:M
Last Name:MARCHETTI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 HIGHWAY 76
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-9203
Mailing Address - Country:US
Mailing Address - Phone:615-672-3905
Mailing Address - Fax:615-672-4210
Practice Address - Street 1:510 HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-9203
Practice Address - Country:US
Practice Address - Phone:615-672-3905
Practice Address - Fax:615-672-4210
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist