MEDICARE: ADVANCED SPECIALTY PHARMACY OF KNOXVILLE, 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	4499	TN

General Provider Information

NPI Number	:	1104057579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED SPECIALTY PHARMACY OF KNOXVILLE, LLC

Provider Business Mailing Address
First Line	:	9947 KINGSTON PIKE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-6923
Country	:	US
Telephone Number	:	865-909-9713
Fax Number	:	865-909-9397

Provider Business Practice Location Address
First Line	:	9947 KINGSTON PIKE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-6923
Country	:	US
Telephone Number	:	865-909-9713
Fax Number	:	865-909-9397

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CHARLES R WALL
Credential	:
Telephone Number	:	865-909-9713

Provider Enumeration Date	:	08/04/2009
Last Update Date	:	10/08/2020

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