Healthcare Provider Details

I. General information

NPI: 1497116529
Provider Name (Legal Business Name): MEDICAL CENTER PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 N OCOEE ST SUITE 301
CLEVELAND TN
37311-3853
US

IV. Provider business mailing address

PO BOX 3240
CLEVELAND TN
37320-3240
US

V. Phone/Fax

Practice location:
  • Phone: 423-472-5548
  • Fax: 423-472-5548
Mailing address:
  • Phone: 423-472-5548
  • Fax: 423-472-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOE SHANNON MOORE
Title or Position: OWNER
Credential:
Phone: 423-472-5548