Crater City Pharmacy

LBN: Peytliv Inc
Crater City Pharmacy is an health care organization with primary practice located at 915 N Broad St , New Tazewell TN 37825-6633. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Peytliv Inc can be contacted via phone (423) 626-5511, or through Robertson, Detra via phone (606) 248-9330.

Contact Information

Primary practice address
915 N Broad St New Tazewell TN 37825-6633
Phone: (423) 626-5511
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Robertson, Detra
Phone: (606) 248-9330

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X PO7862 Kentucky

Profile Details

NPI number 1184114613
LBN Legal business name Peytliv Inc
DBA Doing business as Crater City Pharmacy
Authorized official Robertson, Detra
Entity Organization
Organization subpart 1 No
Enumeration date May 10th, 2018
Last updated Oct 16th, 2023 - about 3 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 1184114613 NPPES
Other 2177440 PK

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