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NPI Code Detail

MEDICARE: MED CENTER PHARMACY LLC

MEDICARE: MED CENTER 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
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy1706TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12095045OTHERPK

General Provider Information

NPI Number : 1861585218
Entity Type Code : Organization
Provider Name (Legal Business Name) : MED CENTER PHARMACY LLC
Provider Business Mailing Address
First Line : 900 W MAIN ST
Second Line :
City : ROGERSVILLE
State : TN
Zip : 37857-2448
Country : US
Telephone Number : 423-272-8104
Fax Number : 423-272-0282
Provider Business Practice Location Address
First Line : 900 W MAIN ST
Second Line :
City : ROGERSVILLE
State : TN
Zip : 37857-2448
Country : US
Telephone Number : 423-272-8104
Fax Number : 423-272-0282
Authorized Official
Title or Position : OWNER AND PHARMACIST
Name : WILLIAM PACK
Credential :
Telephone Number : 423-272-8104
Provider Enumeration Date : 09/30/2006
Last Update Date : 02/16/2015

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