Organization
MEDICAL MALL PHARMACY INC
Active
Organization
MEDICAL MALL PHARMACY INC
Active
Other names
MEDICAL MALL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINE HAGEE (PHARMACY SYSTEMS ANALYST)
(423) 230-8432
Entity
Organization
Contact information
Practice address
1 MEDICAL PARK BLVD, SUITE 106-E, BRISTOL, TN 37620-7430
(423) 844-2888
(423) 844-2891
Mailing address
1 MEDICAL PARK BLVD STE 106, BRISTOL, TN 37620-7430
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2964
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008503257
—
TN
01
—
4428719
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/23/2005
Last updated
04/30/2009
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