=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780757542
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPECIALTY HEALTHCARE PARTNERS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6116 SHALLOWFORD RD STE 118
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37421-7202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-490-0166
-----------------------------------------------------
Fax | 423-490-0168
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6116 SHALLOWFORD RD STE 118
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37421-7202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-490-0166
-----------------------------------------------------
Fax | 423-490-0168
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | MR. WALTER GUICE
-----------------------------------------------------
Credential | RPH.
-----------------------------------------------------
Telephone | 423-490-0166
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 4073
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------