MEDICARE: CAREMAX COMMUNITY 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	3336C0003X	Community/Retail Pharmacy	5551	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2151408	OTHER		PK

General Provider Information

NPI Number	:	1598152498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAREMAX COMMUNITY PHARMACY LLC

Provider Business Mailing Address
First Line	:	418 S GAY ST STE 104
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37902-1134
Country	:	US
Telephone Number	:	865-692-1603
Fax Number	:	865-692-1604

Provider Business Practice Location Address
First Line	:	418 S GAY ST STE 104
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37902-1134
Country	:	US
Telephone Number	:	865-692-1603
Fax Number	:	865-692-1604

Authorized Official
Title or Position	:	CO-OWNER/PHARMACIST
Name	:	CALEB MARCUM SELBY
Credential	:	PHARMD
Telephone Number	:	865-692-1603

Provider Enumeration Date	:	04/20/2015
Last Update Date	:	11/11/2020

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