Provider Demographics
NPI:1821160078
Name:PHL INC
Entity Type:Organization
Organization Name:PHL INC
Other - Org Name:THE DRUGSTORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:PITTMAN
Authorized Official - Last Name:LAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:423-837-6855
Mailing Address - Street 1:335 S CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PITTSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37380-1305
Mailing Address - Country:US
Mailing Address - Phone:423-837-6855
Mailing Address - Fax:423-837-1420
Practice Address - Street 1:335 S CEDAR AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PITTSBURG
Practice Address - State:TN
Practice Address - Zip Code:37380-1305
Practice Address - Country:US
Practice Address - Phone:423-837-6855
Practice Address - Fax:423-837-1420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1322440001Medicare NSC