Healthcare Provider Details

I. General information

NPI: 1619016524
Provider Name (Legal Business Name): UNION PRESCRIPTION OF ELIZABETHTON TENNESSEE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 BEMBERG RD
ELIZABETHTON TN
37643-2938
US

IV. Provider business mailing address

402 BEMBERG RD
ELIZABETHTON TN
37643-2938
US

V. Phone/Fax

Practice location:
  • Phone: 423-543-3508
  • Fax: 423-543-3493
Mailing address:
  • Phone: 423-543-3508
  • Fax: 423-543-3493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number404
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES ANDERSON
Title or Position: PRES/PIC
Credential: DPH
Phone: 423-543-3508