Healthcare Provider Details

I. General information

NPI: 1891744702
Provider Name (Legal Business Name): RONNIE F VISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 TENNESSEE AVE N
PARSONS TN
38363-2002
US

IV. Provider business mailing address

179 TENNESSEE AVE N
PARSONS TN
38363-2002
US

V. Phone/Fax

Practice location:
  • Phone: 731-847-3784
  • Fax: 731-847-6167
Mailing address:
  • Phone: 731-847-3784
  • Fax: 731-847-6167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1418
License Number StateTN

VIII. Authorized Official

Name: RONNIE VISE
Title or Position: OWNER
Credential:
Phone: 731-847-3784