1467410753 NPI number — THE NOWELL CORPORATION

Table of content: (NPI 1467410753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467410753 NPI number — THE NOWELL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE NOWELL CORPORATION
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:
FRESH PHARMACY
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:
1467410753
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 1036
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LENOIR CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37771-1036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-988-0000
Provider Business Mailing Address Fax Number:
865-986-1542

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 HIGHWAY 321 N STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENOIR CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37771-5003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-988-0000
Provider Business Practice Location Address Fax Number:
865-986-1542
Provider Enumeration Date:
05/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NOWELL
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
MOSELEY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
865-719-7476

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0000000699 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 0000002306 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X , with the licence number: 2306 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100045803 . This is a "PHP TENNCARE/MEDICAID" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3545281 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3913534 . This is a "CIGNA MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0570320001 . This is a "BANKERS LIFE &CASUALTY" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0000002306 . This is a "STATE PHARMACY LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4412677 . This is a "NCPDP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 5731367 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3021490 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 591Y1NO . This is a "BCBS OF MINNESOTA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".