Healthcare Provider Details

I. General information

NPI: 1730654708
Provider Name (Legal Business Name): MEDICINE COUNTER 01 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5506 HIGHWAY 153 STE 102
HIXSON TN
37343-5084
US

IV. Provider business mailing address

5506 HIGHWAY 153 STE 102
HIXSON TN
37343-5084
US

V. Phone/Fax

Practice location:
  • Phone: 423-680-7373
  • Fax:
Mailing address:
  • Phone: 423-680-7373
  • Fax: 423-509-8394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierQ045436
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer
# 2
Identifier00006481
Identifier TypeOTHER
Identifier StateTN
Identifier IssuerPHARMACY LICENSE - STATE OF TENNESSEE

VIII. Authorized Official

Name: DR. HIMANSHU ASHOKKUMAR PATEL
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 423-680-7373