# JOHN E MOTHERAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Motheral Super Drug
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891837654
- **Authorized official:** PAUL THOMAS MOTHERAL PHARMD (MANAGER)
- **Authorized official phone:** (731) 352-3242

## Contact information

- **Practice address:** 2340 CEDAR ST, MC KENZIE, TN 38201-2249
- **Practice address phone:** (731) 352-3242
- **Practice address fax:** (731) 352-5860
- **Mailing address:** 2340 CEDAR ST, MC KENZIE, TN 38201-2249
- **Mailing address phone:** (731) 352-3242
- **Mailing address fax:** (731) 352-5860

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 183500000X | Pharmacist | 0000637 | TN | Yes |

## Other

- **Enumeration date:** 02/12/2007
- **Last updated:** 01/09/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1452452 | — | TN |