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General NPI Number Information
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NPI Number | 1083719843
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Entity Type | Organization
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Legal Business Name | RIDDLE AND WALLACE DRUG
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 8 WASHINGTON AVE
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City | ATHENS
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State | TN
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Zip | 37303
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Country | US
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Telephone | 423-745-3383
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Fax | 423-745-3358
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Provider Business Mailing Address
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Address Line | PO BOX 569
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City | ATHENS
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State | TN
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Zip | 37371-0569
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST AND OWNER
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Name | JACK WALLACE
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Credential |
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Telephone | 423-745-3382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 116
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License Number State | TN
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