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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184114613 | NPPES |
| Other | 2177440 | PK |
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