Healthcare Provider Details

I. General information

NPI: 1447047030
Provider Name (Legal Business Name): GEORGETOWN PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8405 HIGHWAY 60
GEORGETOWN TN
37336-4106
US

IV. Provider business mailing address

8375 HWY 60
GEORGETOWN TN
37336
US

V. Phone/Fax

Practice location:
  • Phone: 423-790-0443
  • Fax:
Mailing address:
  • Phone: 423-635-7218
  • Fax: 423-458-6908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JASON BRADLEY
Title or Position: OWNER
Credential: PHARMD
Phone: 423-618-6232