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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