Organization
PHARMCO
Active
Other names
Mouse Creek Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BRADLEY (OWNER)
(423) 790-0443
Entity
Organization
Contact information
Practice address
570 PAUL HUFF PKWY NW, CLEVELAND, TN 37312-2957
(423) 790-0443
(423) 790-0567
Mailing address
570 PAUL HUFF PKWY NW, CLEVELAND, TN 37312-2957
(423) 618-6232
(423) 618-6232
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
6274
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2176846
PK
—
05
—
Q038185
—
TN
Enumeration date
04/04/2018
Last updated
04/07/2022
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