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Organization

EPSB LLC

Active
Other names
Boatwright Pharmacy Atoka
Organization subpart
No

Provider details

NPI number
Authorized official
EMILY PROVENCE (OWNER)
(901) 489-3582
Entity
Organization

Contact information

Practice address
139 WESLEY REED DR STE F, ATOKA, TN 38004-4918
(901) 837-8801
(901) 837-8802
Mailing address
PO BOX 737, ATOKA, TN 38004-0737
(901) 837-8801
(901) 837-8802

Taxonomy

Speciality
Code
Description
License number
State
333600000X
Pharmacy
3336C0003X
Community/Retail Pharmacy
Primary
00003780
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2153440
PK
Enumeration date
11/15/2012
Last updated
02/20/2017
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