Healthcare Provider Details

I. General information

NPI: 1003910068
Provider Name (Legal Business Name): STEWARTS DRUG INC NO 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 PARKWAY
PIGEON FORGE TN
37863-3310
US

IV. Provider business mailing address

PO BOX 116
PIGEON FORGE TN
37868-0116
US

V. Phone/Fax

Practice location:
  • Phone: 865-453-9096
  • Fax: 865-428-1970
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1427
License Number StateTN

VIII. Authorized Official

Name: JERRIE ARUNTHAMAKUN
Title or Position: PHARMACIST
Credential:
Phone: 865-453-9096