Provider Demographics
NPI:1942444799
Name:CENOVA PHARMACEUTICAL CARE
Entity Type:Organization
Organization Name:CENOVA PHARMACEUTICAL CARE
Other - Org Name:CENOVA PHARMACEUTICAL CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:POTEET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-877-4307
Mailing Address - Street 1:1603 HAMILL RD
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4902
Mailing Address - Country:US
Mailing Address - Phone:423-877-4307
Mailing Address - Fax:423-877-9255
Practice Address - Street 1:1603 HAMILL RD
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4902
Practice Address - Country:US
Practice Address - Phone:423-877-4307
Practice Address - Fax:423-877-9255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46443336L0003X
3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4442288OtherNCPDP PROVIDER IDENTIFICATION NUMBER