Provider Demographics
NPI:1730654708
Name:MEDICINE COUNTER 01 INC
Entity Type:Organization
Organization Name:MEDICINE COUNTER 01 INC
Other - Org Name:MEDICINE COUNTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HIMANSHU
Authorized Official - Middle Name:ASHOKKUMAR
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:423-680-7373
Mailing Address - Street 1:5506 HIGHWAY 153 STE 102
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5084
Mailing Address - Country:US
Mailing Address - Phone:423-680-7373
Mailing Address - Fax:423-509-8394
Practice Address - Street 1:5506 HIGHWAY 153 STE 102
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5084
Practice Address - Country:US
Practice Address - Phone:423-680-7373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-05
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ045436Medicaid
TN00006481OtherPHARMACY LICENSE - STATE OF TENNESSEE