Provider Demographics
NPI:1912049503
Name:MUGFORD PHARMACY INC.
Entity Type:Organization
Organization Name:MUGFORD PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECTARY
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-577-5533
Mailing Address - Street 1:3909 MARTIN MILL PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-2456
Mailing Address - Country:US
Mailing Address - Phone:865-577-5533
Mailing Address - Fax:865-577-9959
Practice Address - Street 1:3909 MARTIN MILL PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-2456
Practice Address - Country:US
Practice Address - Phone:865-577-5533
Practice Address - Fax:865-577-9959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4407943OtherNCPDP NUMBER
TN568OtherPHARMACY LICENSE
TN568OtherPHARMACY LICENSE