Healthcare Provider Details

I. General information

NPI: 1902931868
Provider Name (Legal Business Name): BKO STEPHENS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3135 MAIN ST
PIKEVILLE TN
37367
US

IV. Provider business mailing address

PO BOX 829
PIKEVILLE TN
37367
US

V. Phone/Fax

Practice location:
  • Phone: 423-447-2434
  • Fax: 423-447-6151
Mailing address:
  • Phone: 423-447-2434
  • Fax: 423-447-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1068
License Number StateTN

VIII. Authorized Official

Name: MISS KARA G UPCHURCH
Title or Position: PRESIDENT
Credential: OWNER
Phone: 423-447-2434