Provider Demographics
NPI:1225912389
Name:OLIVER, JOE
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:OLIVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 E MOUNTAIN VIEW RD APT 302
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1276
Mailing Address - Country:US
Mailing Address - Phone:423-707-1034
Mailing Address - Fax:
Practice Address - Street 1:414 E MOUNTAIN VIEW RD APT 302
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1276
Practice Address - Country:US
Practice Address - Phone:423-707-1034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-02
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist