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General NPI Number Information
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NPI Number | 1649385683
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Entity Type | Organization
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Legal Business Name | BRAD AND DEBBIE PHELPS INC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 910A TUSCULUM BLVD
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City | GREENEVILLE
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State | TN
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Zip | 37745-4004
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Country | US
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Telephone | 423-787-9544
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Fax | 423-787-1996
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Provider Business Mailing Address
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Address Line | 910A TUSCULUM BLVD
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City | GREENEVILLE
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State | TN
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Zip | 37745-4004
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRAD PHELPS
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Credential |
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Telephone | 423-787-9544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 3145
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License Number State | TN
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