Healthcare Provider Details

I. General information

NPI: 1346332061
Provider Name (Legal Business Name): BULLS GAP PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 HIGHWAY 11 E
BULLS GAP TN
37711-3428
US

IV. Provider business mailing address

412 HIGHWAY 11 E
BULLS GAP TN
37711-3428
US

V. Phone/Fax

Practice location:
  • Phone: 423-235-4600
  • Fax: 423-235-5755
Mailing address:
  • Phone: 423-235-4600
  • Fax: 423-235-5755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3964
License Number StateTN

VIII. Authorized Official

Name: JAMA BOS
Title or Position: OWNER
Credential:
Phone: 423-235-4600