MEDICARE: PRINCETON DRUG

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	3336C0003X	Community/Retail Pharmacy
3	333600000X	Pharmacy	1751	TN

General Provider Information

NPI Number	:	1912900663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRINCETON DRUG

Provider Business Mailing Address
First Line	:	105 BROYLES DR
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2542
Country	:	US
Telephone Number	:	423-282-1178
Fax Number	:	423-282-0462

Provider Business Practice Location Address
First Line	:	105 BROYLES DR
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2542
Country	:	US
Telephone Number	:	423-282-1178
Fax Number	:	423-282-0462

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. MARK A REED
Credential	:
Telephone Number	:	423-282-1178

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	11/13/2015

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Directions to “PRINCETON DRUG ” Practice Location

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