Healthcare Provider Details

I. General information

NPI: 1487723789
Provider Name (Legal Business Name): NT MEDICAL CENTER PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 N BROAD ST
NEW TAZEWELL TN
37825-6610
US

IV. Provider business mailing address

PO BOX 1649
NEW TAZEWELL TN
37824-1649
US

V. Phone/Fax

Practice location:
  • Phone: 423-626-5411
  • Fax: 423-626-6538
Mailing address:
  • Phone: 423-626-5411
  • Fax: 423-626-6538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6090070001
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number446
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number446
License Number StateTN

VIII. Authorized Official

Name: ADAM E BOWLING
Title or Position: OWNER/MEMBER
Credential:
Phone: 423-626-5411