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Organization
MEDICAL MALL PHARMACY INC
Active
Organization
MEDICAL MALL PHARMACY INC
Active
Other names
Stone Drive Outpatient Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CARRIE SWEET (DIRECTOR OF OUTPATIENT PHARMAC)
(423) 230-8435
Entity
Organization
Contact information
Practice address
105 W STONE DR, SUITE 1-B, KINGSPORT, TN 37660-3256
(423) 224-3555
(423) 224-3560
Mailing address
105 W STONE DR, SUITE 1-B, KINGSPORT, TN 37660-3256
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
4582
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4442062
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/04/2008
Last updated
02/20/2009
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