1457457533 NPI number — R & K PHARMACY INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457457533 NPI number — R & K PHARMACY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R & K PHARMACY INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TALLENT DRUG COMPANY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457457533
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 370
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COPPERHILL
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37317-0370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 WEST OCOEE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COPPERHILL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37317-0370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-496-5241
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
CHAD
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST/ PHARMACY MANAGER
Authorized Official Telephone Number:
423-496-5241

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  9457 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000036913A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1452919 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4405696 . This is a "NABP/NCPD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3914368 . This is a "FLUGA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 3914368 . This is a "FLUNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0445270 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3914368 . This is a "FLUTN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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