# KMART PHARMACY 3022

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912361619
- **Authorized official:** DR. CHARLES EDWIN ROBERTS II PHARM.D (PHARMACIST)
- **Authorized official phone:** (423) 968-7032

## Contact information

- **Practice address:** 2854 W STATE ST, BRISTOL, TN 37620-1711
- **Practice address phone:** (423) 968-7032
- **Practice address fax:** (847) 396-2508
- **Mailing address:** 2854 W STATE ST, BRISTOL, TN 37620-1711
- **Mailing address phone:** (423) 968-7032
- **Mailing address fax:** (847) 396-2508

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 183500000X | Pharmacist | 36205 | TN | Yes |

## Other

- **Enumeration date:** 04/08/2016
- **Last updated:** 04/08/2016