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1174834758 NPI number — FORMULAB LLC

NPI Number: 1174834758
Health Care Provider/Practitioner: FORMULAB LLC

Information about “1174834758” NPI (FORMULAB LLC) exists in 1174834758 in HTML format HTML  |  1174834758 in plain Text format TXT  |  1174834758 in PDF (Portable Document Format) PDF  |  1174834758 in an XML format XML  formats.

NPI Number : 1174834758 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174834758",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FORMULAB LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5821 WALDEN DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KNOXVILLE",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37919-6334",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "865-588-0689",
    "MailingAddressFaxNumber": "865-588-0680",
    "FirstLinePracticeLocationAddress": "5821 WALDEN DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KNOXVILLE",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37919-6334",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "865-588-0689",
    "PracticeLocationAddressFaxNumber": "865-588-0680",
    "EnumerationDate": "06/29/2010",
    "LastUpdateDate": "05/16/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "WYATT",
    "AuthorizedOfficialFirstName": "SCOTTY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MEMBER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "865-588-0689",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "333600000X",
          "TaxonomyName": "Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "128",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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