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General NPI Number Information
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NPI Number | 1922182294
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Entity Type | Organization
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Legal Business Name | GEORGE E HOOTEN & ROBERT K GALLOWAY III PTR MANOR PHARMACY
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 4343 LEBANON PIKE SUITE 100
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City | HERMITAGE
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State | TN
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Zip | 37076-1221
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Country | US
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Telephone | 615-883-5522
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Fax | 615-885-0402
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Provider Business Mailing Address
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Address Line | 4343 LEBANON PIKE SUITE 100
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City | HERMITAGE
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State | TN
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Zip | 37076-1221
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Country | US
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Telephone | 615-883-5522
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Fax | 615-885-0402
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Authorized Official
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Title or Position | PHARMACIST - OWNER
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Name | MR. GEORGE EDWARD HOOTEN
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Credential | DPH
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Telephone | 615-883-5522
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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 | 276
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License Number State | TN
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