Healthcare Provider Details

I. General information

NPI: 1447467469
Provider Name (Legal Business Name): BLC DRUG, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 EAST ANDREW JOHNSON HIGHWAY
BULLS GAP TN
37711
US

IV. Provider business mailing address

411 DERBYSHIRE CT
MORRISTOWN TN
37814-1084
US

V. Phone/Fax

Practice location:
  • Phone: 423-235-6263
  • Fax:
Mailing address:
  • Phone: 423-235-6263
  • Fax: 423-235-4792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LAURA CAMPBELL
Title or Position: SECRETARY
Credential: PHARMD
Phone: 423-587-9344