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General NPI Number Information
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NPI Number | 1548606403
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Entity Type | Organization
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Legal Business Name | PETMART PHARMACY, LLC
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 2207 E BROADWAY AVE
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City | MARYVILLE
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State | TN
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Zip | 37804-3078
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Country | US
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Telephone | 877-220-6337
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Fax | 888-908-0198
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Provider Business Mailing Address
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Address Line | 2404 E BROADWAY AVE
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City | MARYVILLE
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State | TN
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Zip | 37804-2759
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Country | US
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Telephone | 877-220-6337
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Fax | 888-908-0198
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Authorized Official
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Title or Position | PHARMACIS IN CHARGE
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Name | DR. EMILY ABBOTT
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Credential | PHARM.D.
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Telephone | 877-220-6337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | 4885
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License Number State | TN
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