1518305069 NPI number — CAREMAX PHARMACY OF LOUDON, INC

Table of content: MRS. BRIDGET NESTER PETRILLO CRNA (NPI 1538271374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518305069 NPI number — CAREMAX PHARMACY OF LOUDON, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAREMAX PHARMACY OF LOUDON, 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:
CAREMAX HOME MEDICAL
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:
1518305069
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3218 MORRIS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37909-1527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-540-1002
Provider Business Mailing Address Fax Number:
865-540-1002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2141 DENTON RD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36303-2379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-350-3166
Provider Business Practice Location Address Fax Number:
334-350-3165
Provider Enumeration Date:
06/06/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHERRILL
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
NOLAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
865-540-1002

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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