Organization
MOUNTAIN STATES MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROOKLYN NELSON PHARMD (PHARMACIST)
(423) 542-7479
Entity
Organization
Contact information
Practice address
1497 W ELK AVE STE 21, ELIZABETHTON, TN 37643-2896
(423) 542-7420
Mailing address
1497 W ELK AVE STE 21, ELIZABETHTON, TN 37643-2896
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
38635
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1982036927
NPI
NC
Enumeration date
09/18/2015
Last updated
09/18/2015
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