MEDICARE: MEDICAL CENTER PHARMACY INC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336C0003X	Community/Retail Pharmacy	00000187	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2095240	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841364379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CENTER PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 3240
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37320-3240
Country	:	US
Telephone Number	:	423-476-5547
Fax Number	:	423-244-2510

Provider Business Practice Location Address
First Line	:	2401 N OCOEE ST
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-3853
Country	:	US
Telephone Number	:	423-476-5547
Fax Number	:	423-472-0125

Authorized Official
Title or Position	:	OWNER
Name	:	JOE SHANNON MOORE
Credential	:
Telephone Number	:	423-476-5548

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	05/07/2025

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Directions to “MEDICAL CENTER PHARMACY INC ” Practice Location

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