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General NPI Number Information
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NPI Number | 1972417137
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Entity Type | Organization
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Legal Business Name | MAYNARDVILLE DRUG LLC
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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Provider Practice Location Address
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Address Line | 2975 MAYNARDVILLE HWY
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City | MAYNARDVILLE
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State | TN
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Zip | 37807-3262
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Country | US
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Telephone | 865-658-5353
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Fax | 865-658-5353
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Provider Business Mailing Address
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Address Line | PO BOX 990
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City | NEW TAZEWELL
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State | TN
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Zip | 37824-0990
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Country | US
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Telephone | 865-658-5353
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Fax | 865-658-5354
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MICHELLE SIMMONS HALFORD
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Credential | PHARM D
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Telephone | 865-278-7895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State | NULL
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