Healthcare Provider Details

I. General information

NPI: 1942444799
Provider Name (Legal Business Name): CENOVA PHARMACEUTICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 HAMILL RD
HIXSON TN
37343-4902
US

IV. Provider business mailing address

1603 HAMILL RD
HIXSON TN
37343-4902
US

V. Phone/Fax

Practice location:
  • Phone: 423-877-4307
  • Fax: 423-877-9255
Mailing address:
  • Phone: 423-877-4307
  • Fax: 423-877-9255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number4644
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES POTEET
Title or Position: PRESIDENT
Credential:
Phone: 423-877-4307