Provider Demographics
NPI:1346510708
Name:MACS PHARMACY#2
Entity Type:Organization
Organization Name:MACS PHARMACY#2
Other - Org Name:MAC'S LONG TERM CARE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILHOIT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:865-945-4441
Mailing Address - Street 1:643 EDGEMOOR RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-7146
Mailing Address - Country:US
Mailing Address - Phone:865-945-4441
Mailing Address - Fax:865-945-4158
Practice Address - Street 1:643 EDGEMOOR RD
Practice Address - Street 2:SUITE B
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-7146
Practice Address - Country:US
Practice Address - Phone:865-945-3333
Practice Address - Fax:865-945-4158
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAC'S PHARMACY#2
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-03
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49723336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4972OtherSTATE OF TENNESSEE