Provider Demographics
NPI:1376756205
Name:SMOKY MOUNTAIN PHARMACY
Entity Type:Organization
Organization Name:SMOKY MOUNTAIN PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERPHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DR PHARMACY
Authorized Official - Phone:865-453-9885
Mailing Address - Street 1:213 FRKS OF RIV PKWY # B
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-3468
Mailing Address - Country:US
Mailing Address - Phone:865-774-1355
Mailing Address - Fax:865-774-1371
Practice Address - Street 1:213 FRKS OF RIV PKWY # B
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3468
Practice Address - Country:US
Practice Address - Phone:865-774-1355
Practice Address - Fax:865-774-1371
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE SMOKE MOUNTAIN COMPANY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty