Healthcare Provider Details

I. General information

NPI: 1679888648
Provider Name (Legal Business Name): MALEAH PHIPPS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30816 BROAD ST
BRUCETON TN
38317-2028
US

IV. Provider business mailing address

30816 BROAD ST
BRUCETON TN
38317-2028
US

V. Phone/Fax

Practice location:
  • Phone: 731-586-2931
  • Fax: 731-586-7888
Mailing address:
  • Phone: 731-586-2931
  • Fax: 731-586-7888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number146
License Number StateTN

VIII. Authorized Official

Name: MALEAH W. HOLLINGSWORTH
Title or Position: OWNER
Credential: PHARM. D.
Phone: 731-586-2931