MEDICARE: CONNIE'SHOMETOWNPHARMACY,INCORPORATED

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

General Provider Information

NPI Number	:	1770233090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNIE'SHOMETOWNPHARMACY,INCORPORATED

Provider Business Mailing Address
First Line	:	646 COSBY HWY
Second Line	:
City	:	NEWPORT
State	:	TN
Zip	:	37821-3418
Country	:	US
Telephone Number	:	423-237-6813
Fax Number	:	423-237-6814

Provider Business Practice Location Address
First Line	:	646 COSBY HWY
Second Line	:
City	:	NEWPORT
State	:	TN
Zip	:	37821-3418
Country	:	US
Telephone Number	:	423-237-6813
Fax Number	:	423-237-6814

Authorized Official
Title or Position	:	PIC
Name	:	DR. CONNIE S SUGGS
Credential	:	DPH
Telephone Number	:	423-237-6813

Provider Enumeration Date	:	03/28/2022
Last Update Date	:	03/29/2024

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