Organization
MEDICAL CENTER PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOE SHANNON MOORE (OWNER)
(423) 472-5548
Entity
Organization
Contact information
Practice address
2401 N OCOEE ST, SUITE 301, CLEVELAND, TN 37311-3853
(423) 472-5548
(423) 472-5548
Mailing address
PO BOX 3240, CLEVELAND, TN 37320-3240
(423) 472-5548
(423) 472-5548
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0128150001
MEDICARE PTAN
—
05
—
3524217
—
TN
Enumeration date
03/17/2016
Last updated
03/17/2016
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