Provider Demographics
NPI:1467410753
Name:THE NOWELL CORPORATION
Entity Type:Organization
Organization Name:THE NOWELL CORPORATION
Other - Org Name:FRESH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MOSELEY
Authorized Official - Last Name:NOWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:865-719-7476
Mailing Address - Street 1:PO BOX 1036
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771-1036
Mailing Address - Country:US
Mailing Address - Phone:865-988-0000
Mailing Address - Fax:865-986-1542
Practice Address - Street 1:721 HIGHWAY 321 N STE 2
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-5003
Practice Address - Country:US
Practice Address - Phone:865-988-0000
Practice Address - Fax:865-986-1542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000699332B00000X
TN00000023063336C0003X
TN23063336C0004X
335E00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100045803OtherPHP TENNCARE/MEDICAID
TN3545281Medicaid
TN3913534OtherCIGNA MEDICARE
TN0570320001OtherBANKERS LIFE &CASUALTY
TN0000002306OtherSTATE PHARMACY LICENSE
TN4412677OtherNCPDP
TN5731367OtherAETNA
TN3021490OtherBLUE CROSS BLUE SHIELD
TN591Y1NOOtherBCBS OF MINNESOTA
TN591Y1NOOtherBCBS OF MINNESOTA
TN3021490OtherBLUE CROSS BLUE SHIELD
TN3913534OtherCIGNA MEDICARE