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General NPI Number Information
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NPI Number | 1629196472
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Entity Type | Organization
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Legal Business Name | MEDICINE CHEST APOTHECARY
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 330 N OAK AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-2440
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Country | US
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Telephone | 931-528-8479
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Fax |
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Provider Business Mailing Address
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Address Line | 330 N OAK AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-2440
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Country | US
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Telephone | 931-528-8479
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. TONY DALE SELLS
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Credential | DPH
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Telephone | 931-528-8479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 00000399
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License Number State | TN
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