Organization
MAC'S MEDICINE MART, INC
Active
Other names
Unique Boutique
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BARRY WALTON DPH (OWNER/PHARMACIST)
(423) 245-2181
Entity
Organization
Contact information
Practice address
1455 E CENTER ST STE 2B, KINGSPORT, TN 37664-2501
(423) 246-2646
(423) 765-9111
Mailing address
1455 E CENTER ST STE 2B, KINGSPORT, TN 37664-2501
(423) 246-2646
(423) 765-9111
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0417510002
—
TN
Enumeration date
12/16/2018
Last updated
12/16/2025
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