Provider Demographics
NPI:1750913083
Name:SWOPE, TABATHA (RPH)
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:
Last Name:SWOPE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 CUMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37757-2431
Mailing Address - Country:US
Mailing Address - Phone:865-258-7458
Mailing Address - Fax:
Practice Address - Street 1:132 CUMBERLAND DR
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-2431
Practice Address - Country:US
Practice Address - Phone:865-258-7458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000042636183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty