Healthcare Provider Details

I. General information

NPI: 1265446553
Provider Name (Legal Business Name): BAGGETT PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E RACE ST
KINGSTON TN
37763-2824
US

IV. Provider business mailing address

133 E RACE ST
KINGSTON TN
37763-2824
US

V. Phone/Fax

Practice location:
  • Phone: 865-376-6452
  • Fax: 865-376-7729
Mailing address:
  • Phone: 865-376-6452
  • Fax: 865-376-7729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number214
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number214
License Number StateTN

VIII. Authorized Official

Name: DR. RONALD JAY BAGGETT
Title or Position: PHARMACIST/OWNER
Credential: PHARM. D.
Phone: 865-376-6452