Provider Demographics
NPI:1770233090
Name:CONNIE'SHOMETOWNPHARMACY,INCORPORATED
Entity type:Organization
Organization Name:CONNIE'SHOMETOWNPHARMACY,INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SUGGS
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:423-237-6813
Mailing Address - Street 1:646 COSBY HWY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-3418
Mailing Address - Country:US
Mailing Address - Phone:423-237-6813
Mailing Address - Fax:423-237-6814
Practice Address - Street 1:646 COSBY HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-3418
Practice Address - Country:US
Practice Address - Phone:423-237-6813
Practice Address - Fax:423-237-6814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy