MEDICARE: SMOKY MOUNTAIN APOTHECARIES NO 2

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	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	05382	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2070359	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730121534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMOKY MOUNTAIN APOTHECARIES NO 2

Provider Business Mailing Address
First Line	:	760 MERRIMON AVE
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28804-2456
Country	:	US
Telephone Number	:	828-255-8757
Fax Number	:	828-255-8829

Provider Business Practice Location Address
First Line	:	760 MERRIMON AVE
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28804-2456
Country	:	US
Telephone Number	:	828-255-8757
Fax Number	:	828-255-8829

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN CLARK
Credential	:	PHARMD
Telephone Number	:	828-255-8757

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	03/30/2016

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Directions to “SMOKY MOUNTAIN APOTHECARIES NO 2 ” Practice Location

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