Organization
MULBERRY STREET PHARMACY LLC
Active
Organization
MULBERRY STREET PHARMACY LLC
Active
Other names
MULBERRY STREET PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JOESPH RATLEDGE PHRMD (PIC)
(865) 458-4586
Entity
Organization
Contact information
Practice address
916 MULBERRY ST, LOUDON, TN 37774-1311
(865) 458-4586
(865) 458-4545
Mailing address
916 MULBERRY ST, LOUDON, TN 37774-1311
(865) 458-4586
(865) 458-4545
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
TN4431
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4440602
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/29/2007
Last updated
09/15/2011
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