=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477698587
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLAIBORNE COUNTY HOSPITAL PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 07/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1850 OLD KNOXVILLE RD
-----------------------------------------------------
City | TAZEWELL
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37879-3625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-526-2224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1850 OLD KNOXVILLE RD
-----------------------------------------------------
City | TAZEWELL
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37879-3625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-526-2224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY
-----------------------------------------------------
Name | MRS. KATHY PAYNE KELLEY
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 423-526-2224
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NR1301X
-----------------------------------------------------
Taxonomy Name | Rural Acute Care Hospital
-----------------------------------------------------
License Number | 1357
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------