Healthcare Provider Details

I. General information

NPI: 1174670129
Provider Name (Legal Business Name): GEORG E HOOTON & ROBERT K GALLOWAY III PTR MANOR PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 LEBANON PIKE SUITE #114
HERMITAGE TN
37076-1221
US

IV. Provider business mailing address

4343 LEBANON PIKE SUITE #100
HERMITAGE TN
37076-1221
US

V. Phone/Fax

Practice location:
  • Phone: 615-883-5169
  • Fax: 615-889-9733
Mailing address:
  • Phone: 615-883-5522
  • Fax: 615-885-0402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0000000688
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number0000000688
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0000000688
License Number StateTN

VIII. Authorized Official

Name: MR. GEORGE EDWARD HOOTEN
Title or Position: OWNER
Credential: DPH
Phone: 615-883-5522