Organization
FORMULAB LLC
Active
Other names
Community Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTTY WYATT (MEMBER)
(865) 588-0689
Entity
Organization
Contact information
Practice address
5821 WALDEN DR, KNOXVILLE, TN 37919-6334
(865) 588-0689
(865) 588-0680
Mailing address
5821 WALDEN DR, KNOXVILLE, TN 37919-6334
(865) 588-0689
(865) 588-0680
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
128
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4443420
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/29/2010
Last updated
05/16/2011
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