Organization
MEDICAL MALL PHARMACY INC
Active
Other names
Stone Drive Outpatient Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CARRIE SWEET (DIRECTOR OF OUTPATIENT PHARMAC)
(423) 230-8435
Entity
Organization
Contact information
Practice address
105 W STONE DR, SUITE 1-B, KINGSPORT, TN 37660-3256
(423) 224-3555
(423) 224-3560
Mailing address
105 W STONE DR, SUITE 1-B, KINGSPORT, TN 37660-3256
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
4582
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4442062
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/04/2008
Last updated
02/20/2009
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