ANDREA BROOKE MIRACLE (NPI# 1003193624) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003193624 |
| Entity Type | Individual |
| Full Name | ANDREA BROOKE MIRACLE |
| Credential | PHARM. D |
| Practice Address |
915 N Broad St New Tazewell TN 37825-6633 |
| Practice Telephone | 4236265511 |
| Practice Fax Number | 4236265544 |
| Enumeration Date | 2011-11-10 |
| Last Update Date | 2011-11-18 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 183500000X | Pharmacist | 014669 | KY | Pharmacy Service Providers |
| Y | 183500000X | Pharmacist | 33135 | TN | Pharmacy Service Providers |
| Street Address |
915 N BROAD ST |
| City | NEW TAZEWELL |
| State | TN |
| Zip Code | 37825-6633 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194996942 | Walgreen Co. | Durable Medical Equipment & Medical Supplies | 915 N Broad St, New Tazewell, TN 37825-6633 | 2008-03-20 |
| 1164029435 | Amber Blevins | Pharmacist | 915 N Broad St, New Tazewell, TN 37825-6633 | 2020-10-08 |
| 1669084711 | Dustin Scott Taylor | Pharmacist | 915 N Broad St, New Tazewell, TN 37825-6633 | 2020-08-20 |
| 1679853303 | Lloyd Benton Harris IIi | Pharmacist | 915 N Broad St, New Tazewell, TN 37825-6633 | 2011-08-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801131610 | Emma Hernandez Tenerife | Physical Therapist | 505 Buchanan Road, New Tazewell, TN 37825 | 2012-12-05 |
| 1295959021 | Melvin Keith Donesky | Dentist | 212 Forrest Ave., New Tazewell, TN 37825 | 2007-04-12 |
| 1962533059 | Lisa Ann Mayes | Case Manager/Care Coordinator | 1596 Highway 33 South, New Tazewell, TN 37825 | 2007-03-08 |
| 1679505937 | James P Crutchfield | Optometrist | 409 N Broad St, New Tazewell, TN 37825 | 2006-07-07 |
| 1497257984 | Selena Frazier | Speech-Language Pathologist | 902 Buchanan Rd, New Tazewell, Tn, TN 37825 | 2018-03-01 |
| 1891211165 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 915 Main St, New Tazewell, TN 37825 | 2017-08-18 |
| 1083169171 | Haley Henard Debusk | Physician Assistant | 424 N. Broad Street, New Tazwell, Tazewell, TN 37825 | 2016-08-18 |
| 1508154055 | Dr.melvin Donesky D.d.s. | Dentist | 212 Forrest Ave., New Tazewell, TN 37825 | 2011-07-19 |
| 1437488350 | William Herbert Brooks | Licensed Practical Nurse | 1596 Highway 33 South, New Tazewell, TN 37825 | 2009-12-24 |
| 1366680423 | Jessica Broyles | Dietitian, Registered | 620 Davis Dr, New Tazewell, TN 37825 | 2009-01-28 |
| Find all providers in zip 37825 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467555094 | Derek Verldon Hicks | Pharmacist | 606 N Broad Street, New Tazewell, TN 37825-6610 | 2006-09-07 |
| 1205436698 | Jacob Seal | Pharmacist | 201 N Broad St, New Tazewell, TN 37825-6603 | 2020-10-27 |
| 1164029435 | Amber Blevins | Pharmacist | 915 N Broad St, New Tazewell, TN 37825-6633 | 2020-10-08 |
| 1669084711 | Dustin Scott Taylor | Pharmacist | 915 N Broad St, New Tazewell, TN 37825-6633 | 2020-08-20 |
| 1689174047 | Wenda Leanne Epperson | Pharmacist | 432 S Broad St, New Tazewell, TN 37825-7239 | 2018-02-12 |
| 1962919266 | Melissa Cosby Johnson | Pharmacist | 432 S Broad St, New Tazewell, TN 37825-7239 | 2018-01-08 |
| 1346796323 | Lacey Eldridge | Pharmacist | 915 Main St, New Tazewell, TN 37825-6651 | 2016-08-30 |
| 1629328315 | Milausha Bagautdinova | Pharmacist | 915 Main St, New Tazewell, TN 37825-6651 | 2012-09-11 |
| 1487922431 | Kristy N Slone | Pharmacist | 915 Main St, New Tazewell, TN 37825-6651 | 2011-12-06 |
| 1679853303 | Lloyd Benton Harris IIi | Pharmacist | 915 N Broad St, New Tazewell, TN 37825-6633 | 2011-08-25 |
| Find all providers in NEW TAZEWELL | ||||
| City | NEW TAZEWELL |
| Zip Code | 37825 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.