Healthcare Provider Details

I. General information

NPI: 1508799917
Provider Name (Legal Business Name): CROSSROADS PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7404 TAZEWELL PIKE
CORRYTON TN
37721-3532
US

IV. Provider business mailing address

7404 TAZEWELL PIKE
CORRYTON TN
37721-3532
US

V. Phone/Fax

Practice location:
  • Phone: 865-866-0124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State

VIII. Authorized Official

Name: DR. MELANIE OWENS
Title or Position: PHARMACY MANAGER
Credential: PHARMD
Phone: 865-922-0124