Organization
KENTON HOWARD PAGE
Active
Other names
Fountain City Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KENTON PAGE BS PHARMACY (PHARMACIST/OWNER)
(865) 688-7025
Entity
Organization
Contact information
Practice address
5034 N BROADWAY ST STE 220, KNOXVILLE, TN 37918-2371
(865) 688-7025
(865) 688-3724
Mailing address
5034 N BROADWAY ST, SUITE 220, KNOXVILLE, TN 37918-2392
(865) 688-7025
(865) 688-3724
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
102
TN
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2089554
PK
—
Enumeration date
01/11/2007
Last updated
05/05/2016
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