Provider Demographics
NPI:1134130701
Name:MP OPERATING LLC DBA MORRISTOWN PHARMACY
Entity Type:Organization
Organization Name:MP OPERATING LLC DBA MORRISTOWN PHARMACY
Other - Org Name:MORRISTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:KRAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:423-587-4949
Mailing Address - Street 1:925 WEST 4TH NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814
Mailing Address - Country:US
Mailing Address - Phone:423-587-4949
Mailing Address - Fax:423-587-4968
Practice Address - Street 1:925 W 4TH NORTH ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3814
Practice Address - Country:US
Practice Address - Phone:423-587-4949
Practice Address - Fax:423-587-4968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN00000004123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1452428Medicaid
TNIA52428Medicaid
2095813OtherPK
TNIA52428Medicaid