Healthcare Provider Details

I. General information

NPI: 1851364483
Provider Name (Legal Business Name): CATES STREET PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 CATES ST
DUNLAP TN
37327-6093
US

IV. Provider business mailing address

PO BOX 1685
DUNLAP TN
37327-1685
US

V. Phone/Fax

Practice location:
  • Phone: 423-949-5722
  • Fax: 423-949-6176
Mailing address:
  • Phone: 423-949-5722
  • Fax: 423-949-6176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number00003967
License Number StateTN

VIII. Authorized Official

Name: JACOB STANDEFER
Title or Position: MANAGER
Credential:
Phone: 423-877-3568