Provider Demographics
NPI:1508145806
Name:PHARMACY NETWORK SERVICES
Entity Type:Organization
Organization Name:PHARMACY NETWORK SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-926-3338
Mailing Address - Street 1:PO BOX 6075
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-6075
Mailing Address - Country:US
Mailing Address - Phone:423-926-3338
Mailing Address - Fax:
Practice Address - Street 1:871 SEVEN OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6481
Practice Address - Country:US
Practice Address - Phone:615-267-0355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMACY NETWORK SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49053336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
6466510001Medicare NSC