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General NPI Number Information
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NPI Number | 1912930926
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Entity Type | Organization
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Legal Business Name | GREENE COUNTY DRUG STORE LLC
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 10/09/2018
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Provider Practice Location Address
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Address Line | 906 TUSCULUM BLVD
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City | GREENEVILLE
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State | TN
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Zip | 37745-4004
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Country | US
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Telephone | 423-638-7101
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Fax | 423-638-9105
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Provider Business Mailing Address
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Address Line | 906 TUSCULUM BLVD
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City | GREENEVILLE
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State | TN
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Zip | 37745-4004
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Country | US
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Telephone | 423-638-7101
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Fax | 423-638-9105
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | BENJIE L. COX
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Credential | DPH
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Telephone | 423-638-7101
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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 | 2221
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License Number State | TN
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