Organization
MAC'S MEDICINE MART, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BARRY WALTON D.PH. (MANAGING EMPLOYEE)
(423) 245-2181
Entity
Organization
Contact information
Practice address
1455 E CENTER ST, KINGSPORT, TN 37664-2501
(423) 245-2181
(423) 245-7261
Mailing address
1455 E CENTER ST, KINGSPORT, TN 37664-2501
(423) 245-2181
(423) 245-7261
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
0417510001
TN
3336C0003X
Community/Retail Pharmacy
Primary
2008
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0417510001
—
TN
01
—
4424824
NCPDP
TN
Enumeration date
09/21/2006
Last updated
08/21/2025
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