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General NPI Number Information
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NPI Number | 1962064337
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Entity Type | Organization
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Legal Business Name | STAR VALLEY PHARMACY
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Dates
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Enumeration Date | 07/05/2019
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Last Update Date | 07/05/2019
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Provider Practice Location Address
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Address Line | 4 E WASHINGTON AVE STE 200
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City | ATHENS
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State | TN
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Zip | 37303-3674
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Country | US
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Telephone | 423-453-5568
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Fax |
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Provider Business Mailing Address
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Address Line | 299 COUNTY ROAD 752
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City | RICEVILLE
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State | TN
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Zip | 37370-5351
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Country | US
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Telephone | 423-453-0623
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Fax |
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Authorized Official
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Title or Position | OWNER/PIC
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Name | DR. MELISSA HALE
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Credential | PHARMD
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Telephone | 423-453-5568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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