Medical Mall Pharmacy

LBN: Medical Mall Pharmacy Inc
Medical Mall Pharmacy is an health care organization with primary practice located at 1 Medical Park Blvd Suite 106-E, Bristol TN 37620-7430. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Medical Mall Pharmacy Inc can be contacted via phone (423) 844-2888, or through Hagee, Kristine via phone (423) 230-8432.

Contact Information

Primary practice address
1 Medical Park Blvd Suite 106-E Bristol TN 37620-7430
Phone: (423) 844-2888
Fax: (423) 844-2891
Website:
Map and Directions
Authorized official contact:
Name: Hagee, Kristine
Phone: (423) 230-8432

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X 2964 Tennessee

Profile Details

NPI number 1598768699
LBN Legal business name Medical Mall Pharmacy Inc
DBA Doing business as Medical Mall Pharmacy
Authorized official Hagee, Kristine
Entity Organization
Organization subpart 1 No
Enumeration date May 23rd, 2005
Last updated Apr 30th, 2009 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598768699 NPPES
Tennessee MEDICAID 008503257
Tennessee Other 4428719

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