Healthcare Provider Details

I. General information

NPI: 1285607044
Provider Name (Legal Business Name): STANDEFER DRUG CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 MAIN ST
PIKEVILLE TN
37367-4919
US

IV. Provider business mailing address

119 MAIN ST
PIKEVILLE TN
37367-4919
US

V. Phone/Fax

Practice location:
  • Phone: 423-447-2134
  • Fax: 423-877-2111
Mailing address:
  • Phone: 423-447-2134
  • Fax: 423-877-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1069
License Number StateTN

VIII. Authorized Official

Name: MR. JOEL STANDEFER
Title or Position: OWNER
Credential:
Phone: 423-447-2134