MEDICAL MALL PHARMACY INC (NPI# 1275536997) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1275536997 |
Entity Type | Organization |
Organization Name | MEDICAL MALL PHARMACY INC |
Other Organization Name | WELLMONT OUTPATIENT PHARMACY |
Practice Address |
130 W Ravine Rd Kingsport TN 37660-3837 |
Practice Telephone | 4232246860 |
Practice Fax Number | 4232245654 |
Mailing Telephone | 4232246860 |
Mailing Fax Number | 4232245654 |
Enumeration Date | 2005-05-27 |
Last Update Date | 2009-12-03 |
Authorized Official Name | KRISTINE HAGEE (PHARMACY SYSTEMS ANALYST) |
Authorized Official Telephone | 4232308432 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 333600000X | Pharmacy | Suppliers | ||
Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
C3413 | TN | Suppliers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
TN | 3130747 | 05 | |
NCPDP PROVIDER IDENTIFICATION NUMBER | 4433378 | 01 | |
VA | 8517916 | 05 |
Other Name | Type Code |
---|---|
Wellmont Outpatient Pharmacy | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1598768699 | Medical Mall Pharmacy Inc | Pharmacy | 1 Medical Park Blvd, Suite 106-e, Bristol, TN 37620-7430 | 2005-05-23 |
1316191349 | Medical Mall Pharmacy Inc | Pharmacy | 105 W Stone Dr, Suite 1-b, Kingsport, TN 37660-3256 | 2008-11-04 |
Street Address |
130 W RAVINE RD |
City | KINGSPORT |
State | TN |
Zip Code | 37660-3837 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1598364903 | Kevin White | Physician Assistant | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-10-19 |
1093328460 | Corbin Noah Turbyfill | Registered Nurse | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-08-26 |
1871106153 | Garon Rick Compton | Registered Nurse | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-08-26 |
1780297010 | Caleb Rumley | Registered Nurse | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-08-26 |
1992314587 | Ryan Earl Farmer | Emergency Medicine | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-07-29 |
1043837933 | Verna Theola Barton | Pharmacist | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-06-26 |
1962028043 | Kendra Lauren O'quinn | Nurse Practitioner | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-06-24 |
1427673672 | Brooke Stayer | Pharmacist | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-06-13 |
1982228847 | Jordan Bacon | Physician Assistant | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-06-05 |
1851914600 | Amy F Kite | Pathology | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-05-27 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1750909891 | Nancy Gober | Pharmacist | Holston Valley Medical Center Inpatient Pharmacy, 130 W Ravine, Kingsport, TN 37660 | 2020-07-06 |
1700437621 | Tammy Denise Leblanc | Technician | 125 Lancer Rd, Kingsport, TN 37660 | 2019-09-23 |
1831743392 | Independent Physical Therapy | Occupational Therapist | 1704 E. Stone Dr. Ste 120, Kingsport, TN 37660 | 2019-08-01 |
1871095315 | Macie Anderson | Nurse Practitioner | 411 Clay St, Kingsport, TN 37660 | 2018-03-01 |
1053813527 | Pulitzer Orthodontics, LLC | Dentist | 1200 Pulitzer Place, Kingsport, TN 37660 | 2018-03-01 |
1174038749 | Sbh-kingsport | Psychiatric Hospital | 1025 Executive Park Blvd, Kingsport, TN 37660 | 2017-12-05 |
1548771447 | Sara B Ball | Registered Nurse | 111 W Stone Dr Ste 240, Kingsport, TN 37660 | 2017-10-18 |
1821525361 | Ashley Brook Weems | Nurse Practitioner | Six Sheridan Square Suite 100, Kingsport, TN 37660 | 2017-05-15 |
1639625643 | Stephanie H Garris | Nurse Practitioner | 117 W Sevier Ave Ste 120, Kingsport, TN 37660 | 2016-08-30 |
1073965679 | Teresa Anne Starke | Physician Assistant | 8 Sheridan Square, Suite 110, Kingsport, TN 37660 | 2016-07-07 |
Find all providers in zip 37660 |
Taxonomy Code | 3336C0003X |
Grouping | Suppliers |
Classification | Pharmacy |
Specialization | Community/Retail Pharmacy |
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1619003399 | Colonial Heights Pharmacy, Inc. | Pharmacy | 4221 Ft. Henry Drive, Kingsport, TN 37663 | 2007-02-26 |
1043313745 | Tennessee Cvs Pharmacy LLC | Pharmacy | 128 W Stone Dr, Kingsport, TN 37660-3221 | 2006-09-07 |
1700989159 | Tennessee Cvs Pharmacy LLC | Pharmacy | 4400 W Stone Dr, Kingsport, TN 37660-1051 | 2006-09-07 |
1871696583 | Tennessee Cvs Pharmacy LLC | Pharmacy | 4106 Fort Henry Dr, Kingsport, TN 37663-2226 | 2006-09-07 |
1861403446 | Wilson Pharmacy Inc | Pharmacy | 1657 E Stone Dr, Ste A, Kingsport, TN 37660-4669 | 2006-08-10 |
1245247261 | Walgreen Co | Pharmacy | 4500 W Stone Dr, Kingsport, TN 37660-1049 | 2006-08-02 |
1508871542 | Walgreen Co | Pharmacy | 3900 Fort Henry Dr, Kingsport, TN 37663-2026 | 2006-07-29 |
1992326664 | Jj Beans At P&s LLC | Pharmacy | 613 Watauga St, Kingsport, TN 37660-4429 | 2020-05-04 |
1902320989 | K & M Pharmacy PC | Pharmacy | 4221 Fort Henry Dr, Kingsport, TN 37663-2227 | 2017-08-01 |
1407274707 | Ingles Markets Inc | Pharmacy | 4335 Fort Henry Dr, Kingsport, TN 37664 | 2014-04-03 |
Find all providers in KINGSPORT |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.