Provider Demographics
NPI:1982621959
Name:MAC'S PHARMACY 2
Entity Type:Organization
Organization Name:MAC'S PHARMACY 2
Other - Org Name:MAC'S EDGEMOOR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILHOIT
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:865-945-3333
Mailing Address - Street 1:643 EDGEMOOR RD
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-7146
Mailing Address - Country:US
Mailing Address - Phone:865-945-3333
Mailing Address - Fax:865-945-3449
Practice Address - Street 1:643 EDGEMOOR RD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-7146
Practice Address - Country:US
Practice Address - Phone:865-945-3333
Practice Address - Fax:865-945-3449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X
TN6113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2095986OtherPK
4410914OtherNCPDP PROVIDER IDENTIFICATION NUMBER