Organization
MAYNARDVILLE PHARMACY INC
Active
Other names
Okie's Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RAJENDRAPRASAD VENIGALLA (SECRETARY)
(347) 528-8893
Entity
Organization
Contact information
Practice address
4221 MAYNARDVILLE HWY, MAYNARDVILLE, TN 37807-3555
(865) 992-9455
(865) 992-7979
Mailing address
4221 MAYNARDVILLE HWY, MAYNARDVILLE, TN 37807-3555
(865) 992-9455
(865) 992-7979
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
3435
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2123620
PK
—
05
—
Q033563
—
TN
Enumeration date
07/22/2006
Last updated
04/13/2020
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