Provider Demographics
NPI:1427775204
Name:ABUNDANT PHARMACY SERVICES LLC
Entity type:Organization
Organization Name:ABUNDANT PHARMACY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARROD
Authorized Official - Middle Name:
Authorized Official - Last Name:VICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-608-5475
Mailing Address - Street 1:2706 W HIGHWAY 11E
Mailing Address - Street 2:
Mailing Address - City:STRAWBERRY PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37871-3432
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2706 W HIGHWAY 11E
Practice Address - Street 2:
Practice Address - City:STRAWBERRY PLAINS
Practice Address - State:TN
Practice Address - Zip Code:37871-3432
Practice Address - Country:US
Practice Address - Phone:865-233-8071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy