Healthcare Provider Details

I. General information

NPI: 1285793653
Provider Name (Legal Business Name): MARKS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 CREEK ST
LAKE CITY TN
37769
US

IV. Provider business mailing address

PO BOX 1035
LAKE CITY TN
37769-1035
US

V. Phone/Fax

Practice location:
  • Phone: 865-426-2186
  • Fax: 865-426-9200
Mailing address:
  • Phone: 865-300-8084
  • Fax: 865-426-9200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1352
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARK SMITH
Title or Position: PRESIDENT CEO
Credential:
Phone: 865-426-2186