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General NPI Number Information
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NPI Number | 1700908001
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Entity Type | Organization
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Legal Business Name | COMPOUNDING PHARMACY OF KINGSTON INC
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 145 E RACE ST
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City | KINGSTON
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State | TN
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Zip | 37763-2824
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Country | US
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Telephone | 865-376-6452
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Fax | 865-376-7729
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Provider Business Mailing Address
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Address Line | 145 E RACE ST
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City | KINGSTON
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State | TN
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Zip | 37763-2824
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Country | US
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Telephone | 865-376-6452
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Fax | 865-376-7729
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Authorized Official
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Title or Position | OWNER
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Name | RONALD BAGGETT
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Credential | PHARMD
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Telephone | 865-376-6452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 3632
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License Number State | TN
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