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General NPI Number Information
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NPI Number | 1275622961
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Entity Type | Organization
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Legal Business Name | OLDE TOWNE PHARMACY INC
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 102 W JACKSON BLVD
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City | JONESBOROUGH
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State | TN
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Zip | 37659-1224
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Country | US
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Telephone | 423-753-4446
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Fax | 423-753-4587
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Provider Business Mailing Address
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Address Line | 102 W JACKSON BLVD
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City | JONESBOROUGH
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State | TN
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Zip | 37659-1224
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Country | US
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Telephone | 423-753-4446
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Fax | 423-753-4587
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Authorized Official
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Title or Position | PRESIDENT/PHARMACIST IN CHARGE
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Name | JOSHUA NOLEN CLOYD
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Credential |
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Telephone | 423-753-4446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 1980
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License Number State | TN
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