Organization
MEDI MART PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOE MOORE (OWNER)
(423) 476-7947
Entity
Organization
Contact information
Practice address
5030 GEORGETOWN RD NW, CLEVELAND, TN 37312-1309
(423) 472-5548
(423) 472-6400
Mailing address
PO BOX 3240, CLEVELAND, TN 37320-3240
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
0000000354
TN
333600000X
Pharmacy
Primary
0000000354
TN
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4439255
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/30/2006
Last updated
04/20/2008
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