Healthcare Provider Details

I. General information

NPI: 1912583691
Provider Name (Legal Business Name): PATRICK BRYAN COX SR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 POPLAR ST
MT CARMEL TN
37645-3317
US

IV. Provider business mailing address

264 POPLAR ST
MOUNT CARMEL TN
37645-3317
US

V. Phone/Fax

Practice location:
  • Phone: 423-470-2730
  • Fax:
Mailing address:
  • Phone: 423-470-2730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number006167
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: