=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457457533
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R & K PHARMACY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 WEST OCOEE STREET
-----------------------------------------------------
City | COPPERHILL
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37317-0370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-496-5241
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 370
-----------------------------------------------------
City | COPPERHILL
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37317-0370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST/ PHARMACY MANAGER
-----------------------------------------------------
Name | MR. CHAD SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 423-496-5241
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 9457
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------