MEDICARE: PREFERRED FAMILY PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	4091	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2094609	OTHER		PK

General Provider Information

NPI Number	:	1558476598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED FAMILY PHARMACY LLC

Provider Business Mailing Address
First Line	:	PO BOX 455
Second Line	:
City	:	CHARLESTON
State	:	TN
Zip	:	37310-0455
Country	:	US
Telephone Number	:	423-336-5522
Fax Number	:	423-680-6101

Provider Business Practice Location Address
First Line	:	8896 HIWASSEE ST NW
Second Line	:
City	:	CHARLESTON
State	:	TN
Zip	:	37310-5340
Country	:	US
Telephone Number	:	423-336-5522
Fax Number	:	423-680-6101

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	JAMES GRIFFIN
Credential	:	DPH
Telephone Number	:	423-336-5522

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	05/01/2020

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Directions to “PREFERRED FAMILY PHARMACY LLC ” Practice Location

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