Provider Demographics
NPI:1053924266
Name:MADDOX, MARCUS MONROE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:MONROE
Last Name:MADDOX
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7336 ANTOINETTE WAY APT 305
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5991
Mailing Address - Country:US
Mailing Address - Phone:423-335-0549
Mailing Address - Fax:
Practice Address - Street 1:11305 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-4811
Practice Address - Country:US
Practice Address - Phone:865-579-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist