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General NPI Number Information
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NPI Number | 1740647338
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Entity Type | Organization
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Legal Business Name | SEVIERVILLE WORX LLC
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Dates
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Enumeration Date | 01/27/2016
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 1024 MIDDLE CREEK RD
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City | SEVIERVILLE
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State | TN
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Zip | 37862-6921
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Country | US
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Telephone | 865-366-1770
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Fax | 865-366-1771
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Provider Business Mailing Address
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Address Line | 1024 MIDDLE CREEK RD SUITE 1
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City | SEVIERVILLE
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State | TN
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Zip | 37862-6921
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Country | US
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Telephone | 865-366-1770
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Fax | 865-366-1771
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | ROBERT WAYNE BULLINGTON
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Credential | PHARMD
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Telephone | 865-366-1770
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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 | 0000005729
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License Number State | TN
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