MEDICARE: STANIFER PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0003X	Community/Retail Pharmacy	4057	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2159557	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083782221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STANIFER PHARMACY LLC

Provider Business Mailing Address
First Line	:	PO BOX 1438
Second Line	:
City	:	NEW TAZEWELL
State	:	TN
Zip	:	37824-1438
Country	:	US
Telephone Number	:	423-626-7337
Fax Number	:	423-626-0189

Provider Business Practice Location Address
First Line	:	420 N BROAD ST
Second Line	:
City	:	NEW TAZEWELL
State	:	TN
Zip	:	37825-6606
Country	:	US
Telephone Number	:	423-626-7337
Fax Number	:	423-626-0189

Authorized Official
Title or Position	:	PHARMACIST/OWNER
Name	:	RUSSELL ESSARY
Credential	:
Telephone Number	:	423-626-7337

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	03/27/2017

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Directions to “STANIFER PHARMACY LLC ” Practice Location

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