=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770233090
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONNIE'SHOMETOWNPHARMACY,INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2022
-----------------------------------------------------
Last Update Date | 03/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 646 COSBY HWY
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37821-3418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-237-6813
-----------------------------------------------------
Fax | 423-237-6814
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 646 COSBY HWY
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37821-3418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-237-6813
-----------------------------------------------------
Fax | 423-237-6814
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PIC
-----------------------------------------------------
Name | DR. CONNIE S SUGGS
-----------------------------------------------------
Credential | DPH
-----------------------------------------------------
Telephone | 423-237-6813
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------