Provider Demographics
NPI:1992300743
Name:VANCE, KARRIE BROOKE (PHARM D)
Entity type:Individual
Prefix:
First Name:KARRIE
Middle Name:BROOKE
Last Name:VANCE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6681 BRISTOL HWY
Mailing Address - Street 2:
Mailing Address - City:PINEY FLATS
Mailing Address - State:TN
Mailing Address - Zip Code:37686-5232
Mailing Address - Country:US
Mailing Address - Phone:423-538-0253
Mailing Address - Fax:
Practice Address - Street 1:6681 BRISTOL HWY
Practice Address - Street 2:
Practice Address - City:PINEY FLATS
Practice Address - State:TN
Practice Address - Zip Code:37686-5232
Practice Address - Country:US
Practice Address - Phone:423-538-0253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207625183500000X
TN27180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist