Organization
MICHIE PHARMACY INC
Active
Other names
MICHIE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN ODOM DPH (OWNER AND PHCT)
(731) 239-2100
Entity
Organization
Contact information
Practice address
5823 HIGHWAY 22, MICHIE, TN 38357-5175
(731) 239-2100
(731) 239-2102
Mailing address
5823 HIGHWAY 22, MICHIE, TN 38357-5175
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
3311
TN
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
195249188
—
TN
01
—
2092448
PK
—
Enumeration date
10/13/2006
Last updated
01/22/2016
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