Healthcare Provider Details

I. General information

NPI: 1477657435
Provider Name (Legal Business Name): KINGWOOD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3824 RINGGOLD RD
CHATTANOOGA TN
37412-1640
US

IV. Provider business mailing address

3824 RINGGOLD RD
CHATTANOOGA TN
37412-1640
US

V. Phone/Fax

Practice location:
  • Phone: 423-629-1434
  • Fax: 423-629-9646
Mailing address:
  • Phone: 423-629-1434
  • Fax: 423-629-9646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number277
License Number StateTN

VIII. Authorized Official

Name: JOE MUSICK
Title or Position: PRESIDENT
Credential:
Phone: 423-629-1434