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Organization
TAKOMA REGIONAL HOSPITAL INC
Active
Organization
TAKOMA REGIONAL HOSPITAL INC
Active
Other names
BH Specialty Pharmacy- GVL
Organization subpart
No
Provider details
NPI number
Authorized official
MARY LYNN KRUTAK (EVP/CFO)
(423) 302-3423
Entity
Organization
Contact information
Practice address
1420 TUSCULUM BLVD, GREENEVILLE, TN 37745-4279
(423) 787-5060
(423) 610-3366
Mailing address
2 PROFESSIONAL PARK DR STE 15, JOHNSON CITY, TN 37604-6584
(423) 434-7443
(423) 302-3537
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3370042
—
TN
Enumeration date
03/31/2021
Last updated
08/12/2022
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