Organization
SIYAA HEALTHCARE LLC
Active
Other names
Tiny Town Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAULIK PATEL PHARMD (OFFICER)
(000) 000-0000
Entity
Organization
Contact information
Practice address
1790 TINY TOWN RD STE B, CLARKSVILLE, TN 37042-7636
(931) 378-6292
(931) 378-6293
Mailing address
1790 TINY TOWN RD STE B, CLARKSVILLE, TN 37042-7636
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q070836
—
TN
Enumeration date
10/29/2021
Last updated
03/25/2022
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