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General NPI Number Information
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NPI Number | 1083417414
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Entity Type | Organization
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Legal Business Name | STANIFER PHARMACY LLC
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 420 N BROAD ST
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City | NEW TAZEWELL
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State | TN
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Zip | 37825-6606
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Country | US
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Telephone | 423-626-7337
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Fax | 423-626-0189
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Provider Business Mailing Address
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Address Line | PO BOX 1438
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City | NEW TAZEWELL
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State | TN
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Zip | 37824-1438
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Country | US
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Telephone | 423-626-7337
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Fax | 423-626-0189
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Authorized Official
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Title or Position | OWNER
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Name | RUSSELL ESSARY
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Credential |
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Telephone | 423-626-7337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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