Provider Demographics
NPI:1912123910
Name:FLANAGAN, JEFFREY A (RPH)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:A
Last Name:FLANAGAN
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 1:6440 SEA HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3179
Mailing Address - Country:US
Mailing Address - Phone:423-580-3520
Mailing Address - Fax:423-785-3416
Practice Address - Street 1:100 MOCCASIN BEND RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-4415
Practice Address - Country:US
Practice Address - Phone:423-785-3415
Practice Address - Fax:423-785-3416
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist