Provider Demographics
NPI:1790186401
Name:MARK H KOLARSKY
Entity Type:Organization
Organization Name:MARK H KOLARSKY
Other - Org Name:FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-348-6101
Mailing Address - Street 1:1025 HIGHWAY 93
Mailing Address - Street 2:
Mailing Address - City:FALL BRANCH
Mailing Address - State:TN
Mailing Address - Zip Code:37656-1844
Mailing Address - Country:US
Mailing Address - Phone:423-348-6101
Mailing Address - Fax:423-348-6716
Practice Address - Street 1:1025 HIGHWAY 93
Practice Address - Street 2:
Practice Address - City:FALL BRANCH
Practice Address - State:TN
Practice Address - Zip Code:37656-1844
Practice Address - Country:US
Practice Address - Phone:423-348-6101
Practice Address - Fax:423-348-6716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN00000001233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1790186401Medicaid
2148064OtherPK