Organization
RIDDLE AND WALLACE DRUG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK WALLACE (PHARMACIST AND OWNER)
(423) 745-3382
Entity
Organization
Contact information
Practice address
8 WASHINGTON AVE, ATHENS, TN 37303
(423) 745-3383
(423) 745-3358
Mailing address
PO BOX 569, ATHENS, TN 37371-0569
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
116
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3540727
—
TN
01
—
4404341
OTHER ID NUMBER
—
Enumeration date
09/14/2006
Last updated
06/05/2008
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