Healthcare Provider Details

I. General information

NPI: 1699977975
Provider Name (Legal Business Name): ADAMSVILLE FAMILY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 E MAIN ST
ADAMSVILLE TN
38310-2458
US

IV. Provider business mailing address

PO BOX 253
ADAMSVILLE TN
38310-0253
US

V. Phone/Fax

Practice location:
  • Phone: 731-632-1730
  • Fax: 731-632-9954
Mailing address:
  • Phone: 731-632-1730
  • Fax: 731-632-9954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3670
License Number StateTN

VIII. Authorized Official

Name: MRS. VALERIE ANN WILLIAMS
Title or Position: PHARMACIST
Credential: DPH
Phone: 17316321730