Provider Demographics
NPI:1619016524
Name:UNION PRESCRIPTION OF ELIZABETHTON TENNESSEE INC
Entity Type:Organization
Organization Name:UNION PRESCRIPTION OF ELIZABETHTON TENNESSEE INC
Other - Org Name:UNION PRESCRIPTION SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES/PIC
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:423-543-3508
Mailing Address - Street 1:402 BEMBERG RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2938
Mailing Address - Country:US
Mailing Address - Phone:423-543-3508
Mailing Address - Fax:423-543-3493
Practice Address - Street 1:402 BEMBERG RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2938
Practice Address - Country:US
Practice Address - Phone:423-543-3508
Practice Address - Fax:423-543-3493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4043336C0003X
3336C0004X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4403109OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TN3533062Medicaid
TN3533062Medicaid