Provider Demographics
NPI:1871025718
Name:BAGGETT PHARMACY, INC
Entity Type:Organization
Organization Name:BAGGETT PHARMACY, INC
Other - Org Name:BAGGETT HEALTHMART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-376-6452
Mailing Address - Street 1:133 E RACE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-2824
Mailing Address - Country:US
Mailing Address - Phone:865-376-6452
Mailing Address - Fax:865-376-7729
Practice Address - Street 1:133 E RACE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-2824
Practice Address - Country:US
Practice Address - Phone:865-376-6452
Practice Address - Fax:865-376-7729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN2143336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2168405OtherPK
TN1452133Medicaid
1028210001Medicare NSC