Healthcare Provider Details

I. General information

NPI: 1225236870
Provider Name (Legal Business Name): ACCESS SPECIALIZED CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4062 HIXSON PIKE STE C
CHATTANOOGA TN
37415-3110
US

IV. Provider business mailing address

4062 HIXSON PIKE STE C
CHATTANOOGA TN
37415-3110
US

V. Phone/Fax

Practice location:
  • Phone: 423-877-3568
  • Fax: 423-362-4875
Mailing address:
  • Phone: 423-877-3568
  • Fax: 423-362-4875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number4423
License Number StateTN

VIII. Authorized Official

Name: MAX STANDEFER
Title or Position: OWNER
Credential: RPH
Phone: 423-877-3568