Healthcare Provider Details

I. General information

NPI: 1336142280
Provider Name (Legal Business Name): MEDICATION MANAGEMENT CENTER, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E CENTER ST STE 200
KINGSPORT TN
37660-4973
US

IV. Provider business mailing address

1000 E CENTER ST STE 200
KINGSPORT TN
37660-4973
US

V. Phone/Fax

Practice location:
  • Phone: 423-378-6337
  • Fax: 423-378-6333
Mailing address:
  • Phone: 423-378-6337
  • Fax: 423-378-6333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number0000008550
License Number StateTN

VIII. Authorized Official

Name: DR. BILLIE J MINTON
Title or Position: OWNER AND DOCTOR OF PHARMACOLOGY
Credential: PHARM.D.
Phone: 423-378-6337