Provider Demographics
NPI:1457604357
Name:SMYRNA PHARMACY AND WELLNESS INC
Entity Type:Organization
Organization Name:SMYRNA PHARMACY AND WELLNESS INC
Other - Org Name:SMYRNA PHARMACY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FICHTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-462-6031
Mailing Address - Street 1:361 ENON SPRINGS RD E
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-3012
Mailing Address - Country:US
Mailing Address - Phone:615-438-5454
Mailing Address - Fax:615-984-7985
Practice Address - Street 1:361 ENON SPRINGS RD E
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-3012
Practice Address - Country:US
Practice Address - Phone:615-462-6031
Practice Address - Fax:615-984-7985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336L0003X
TN000050673336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2137353OtherPK
7252350001Medicare PIN