Organization
GEORG E HOOTON & ROBERT K GALLOWAY III PTR MANOR PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEORGE EDWARD HOOTEN DPH (OWNER)
(615) 883-5522
Entity
Organization
Contact information
Practice address
4343 LEBANON PIKE, SUITE #114, HERMITAGE, TN 37076-1221
(615) 883-5169
(615) 889-9733
Mailing address
4343 LEBANON PIKE, SUITE #100, HERMITAGE, TN 37076-1221
(615) 883-5522
(615) 885-0402
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0000000688
TN
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
0000000688
TN
332BX2000X
Oxygen Equipment & Supplies (DME)
0000000688
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
68401
—
TN
Enumeration date
01/04/2007
Last updated
07/03/2008
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