Provider Demographics
NPI:1275894735
Name:BLOUNT DISCOUNT PHARMACY INC
Entity Type:Organization
Organization Name:BLOUNT DISCOUNT PHARMACY INC
Other - Org Name:BLOUNT DISCOUNT PHARMACY-LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT /PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:HAMILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:865-681-0520
Mailing Address - Street 1:131 MONTGOMERY LN
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-5649
Mailing Address - Country:US
Mailing Address - Phone:865-681-0520
Mailing Address - Fax:865-681-8226
Practice Address - Street 1:152 BMH PHYSICIANS OFFICE BLDG
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5902
Practice Address - Country:US
Practice Address - Phone:865-379-8524
Practice Address - Fax:865-983-8758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
TN49863336L0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135366OtherPK
TN1534059Medicaid