Provider Demographics
NPI:1275861635
Name:TOWN & COUNTRY PHARMACY
Entity Type:Organization
Organization Name:TOWN & COUNTRY PHARMACY
Other - Org Name:TOWN & COUNTRY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-798-9000
Mailing Address - Street 1:771 COSBY HWY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-3426
Mailing Address - Country:US
Mailing Address - Phone:423-623-1500
Mailing Address - Fax:423-625-1196
Practice Address - Street 1:910 TUSCULUM BLVD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4004
Practice Address - Country:US
Practice Address - Phone:423-798-9000
Practice Address - Fax:423-798-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4710333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4442795OtherNCPDP PROVIDER IDENTIFICATION NUMBER