Provider Demographics
NPI:1487723789
Name:NT MEDICAL CENTER PHARMACY, LLC
Entity type:Organization
Organization Name:NT MEDICAL CENTER PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-626-5411
Mailing Address - Street 1:PO BOX 1649
Mailing Address - Street 2:
Mailing Address - City:NEW TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37824-1649
Mailing Address - Country:US
Mailing Address - Phone:423-626-5411
Mailing Address - Fax:423-626-6538
Practice Address - Street 1:606 N BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37825-6610
Practice Address - Country:US
Practice Address - Phone:423-626-5411
Practice Address - Fax:423-626-6538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4463336C0004X, 3336C0003X
6090070001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4410572OtherNCPDP
TN6090070001Medicare NSC
4410572OtherNCPDP