Organization
PHARMACY SPECIALTY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN BEVINS (OWNER)
(423) 928-3130
Entity
Organization
Contact information
Practice address
1301 N ROAN ST, JOHNSON CITY, TN 37601-3941
(423) 928-3130
(423) 928-2249
Mailing address
1301 N ROAN ST, JOHNSON CITY, TN 37601-3941
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
0000003619
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4440878
OTHER ID NUMBER
—
Enumeration date
01/02/2008
Last updated
06/05/2008
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