Organization
MAC'S PHARMACY 2
Active
Other names
MAC'S EDGEMOOR PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL WILHOIT PHRMD (VICE PRESIDENT)
(865) 945-3333
Entity
Organization
Contact information
Practice address
643 EDGEMOOR RD, POWELL, TN 37849-7146
(865) 945-3333
(865) 945-3449
Mailing address
643 EDGEMOOR RD, POWELL, TN 37849-7146
(865) 945-3333
(865) 945-3449
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
611
TN
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2095986
PK
—
Enumeration date
07/16/2006
Last updated
01/17/2017
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