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General NPI Number Information
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NPI Number | 1831272129
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Entity Type | Organization
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Legal Business Name | MINNIS DRUG STORE INC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 1250 TENNOVA MEDICAL WAY
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City | KNOXVILLE
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State | TN
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Zip | 37909-3120
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Country | US
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Telephone | 865-895-6072
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 369
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City | MORRISTOWN
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State | TN
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Zip | 37815-0369
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Country | US
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Telephone | 423-586-4562
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Fax | 423-587-5537
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Authorized Official
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Title or Position | OWNER CHIEF PHARMICIST
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Name | MR. ROBERT KENNETH CANTWELL
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Credential | DPH PHARMACY
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Telephone | 423-586-4562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0003X
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Taxonomy Name | Managed Care Organization Pharmacy
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License Number | 0000001975
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License Number State | TN
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