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General NPI Number Information
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NPI Number | 1417223330
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Entity Type | Organization
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Legal Business Name | EDDIES DRUG STORE LLC
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Dates
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Enumeration Date | 03/25/2012
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Last Update Date | 07/17/2012
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Provider Practice Location Address
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Address Line | 1240 FOX MEADOWS BLVD STE 3
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City | SEVIERVILLE
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State | TN
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Zip | 37862-6928
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Country | US
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Telephone | 865-286-9079
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Fax | 865-286-9016
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Provider Business Mailing Address
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Address Line | 1240 FOX MEADOWS BLVD STE #3
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City | SEVIERVILLE
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State | TN
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Zip | 37862-6928
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Country | US
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Telephone | 865-286-9079
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Fax | 865-286-9016
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Authorized Official
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Title or Position | OWNER/PHARMACIST IN CHARGE
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Name | EDDIE LEWIS
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Credential |
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Telephone | 865-286-9079
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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 | 5003
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License Number State | TN
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