Provider Demographics
NPI:1003910068
Name:STEWARTS DRUG INC NO 2
Entity Type:Organization
Organization Name:STEWARTS DRUG INC NO 2
Other - Org Name:STEWARTS DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARUNTHAMAKUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-453-9096
Mailing Address - Street 1:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:PIGEON FORGE
Mailing Address - State:TN
Mailing Address - Zip Code:37868-0116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3120 PARKWAY
Practice Address - Street 2:
Practice Address - City:PIGEON FORGE
Practice Address - State:TN
Practice Address - Zip Code:37863-3310
Practice Address - Country:US
Practice Address - Phone:865-453-9096
Practice Address - Fax:865-428-1970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN14273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1452430Medicaid
2088284OtherPK
0124350001Medicare NSC