Healthcare Provider Details

I. General information

NPI: 1821160078
Provider Name (Legal Business Name): PHL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 S CEDAR AVE
SOUTH PITTSBURG TN
37380-1305
US

IV. Provider business mailing address

335 S CEDAR AVE
SOUTH PITTSBURG TN
37380-1305
US

V. Phone/Fax

Practice location:
  • Phone: 423-837-6855
  • Fax: 423-837-1420
Mailing address:
  • Phone: 423-837-6855
  • Fax: 423-837-1420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3417
License Number StateTN

VIII. Authorized Official

Name: EMILY PITTMAN LAYNE
Title or Position: OWNER/PHARMACIST
Credential: DPH
Phone: 423-837-6855