Provider Demographics
NPI:1235707340
Name:MACS PHARMACY AT SOUTH PETERS
Entity Type:Organization
Organization Name:MACS PHARMACY AT SOUTH PETERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:865-256-9845
Mailing Address - Street 1:125 S PETERS RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5202
Mailing Address - Country:US
Mailing Address - Phone:865-381-2500
Mailing Address - Fax:855-571-3531
Practice Address - Street 1:125 S PETERS RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5202
Practice Address - Country:US
Practice Address - Phone:865-381-2500
Practice Address - Fax:855-571-3531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy