MEDICARE: T.G.B.T.G. ENTERPRISE 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	183500000X	Pharmacist	5207	TN

General Provider Information

NPI Number	:	1912348830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T.G.B.T.G. ENTERPRISE INC.

Provider Business Mailing Address
First Line	:	702 W HIGHWAY 25 70
Second Line	:
City	:	NEWPORT
State	:	TN
Zip	:	37821-9020
Country	:	US
Telephone Number	:	423-625-6178
Fax Number	:	423-625-6180

Provider Business Practice Location Address
First Line	:	702 W HIGHWAY 25 70
Second Line	:
City	:	NEWPORT
State	:	TN
Zip	:	37821-9020
Country	:	US
Telephone Number	:	423-625-6178
Fax Number	:	423-625-6180

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	DR. CHARLES BRUCE BOGGS II
Credential	:	PHARM.D.
Telephone Number	:	423-923-4695

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	07/08/2013

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