Provider Demographics
NPI:1467645986
Name:MARKS PHARMACY
Entity Type:Organization
Organization Name:MARKS PHARMACY
Other - Org Name:MARKS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-426-2186
Mailing Address - Street 1:106 CREEK ST
Mailing Address - Street 2:PO BOX 1035
Mailing Address - City:LAKE CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37769
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 CREEK ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:TN
Practice Address - Zip Code:37769
Practice Address - Country:US
Practice Address - Phone:865-426-2186
Practice Address - Fax:865-426-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0114773332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3910029Medicaid
4440412OtherOTHER ID NUMBER
TN6004850001Medicare NSC