Provider Demographics
NPI:1942211529
Name:BLOUNT DISCOUNT PHARMACY INC
Entity Type:Organization
Organization Name:BLOUNT DISCOUNT PHARMACY INC
Other - Org Name:BLOUNT DISCOUNT PHARMACY - JOULE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST / PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFOY
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:865-681-6997
Mailing Address - Street 1:260 JOULE ST
Mailing Address - Street 2:
Mailing Address - City:ALCOA
Mailing Address - State:TN
Mailing Address - Zip Code:37701-2459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:260 JOULE ST
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-2459
Practice Address - Country:US
Practice Address - Phone:865-738-0078
Practice Address - Fax:865-738-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454922Medicaid
4437403OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TN1454922Medicaid