Provider Demographics
NPI:1548732928
Name:KINZER PHARMACY, LLC
Entity type:Organization
Organization Name:KINZER PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KINZER
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:931-922-6274
Mailing Address - Street 1:103 PUBLIC SQ
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TN
Mailing Address - Zip Code:38474-1625
Mailing Address - Country:US
Mailing Address - Phone:931-922-6274
Mailing Address - Fax:
Practice Address - Street 1:103 PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TN
Practice Address - Zip Code:38474-1625
Practice Address - Country:US
Practice Address - Phone:931-922-6274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN47798OtherTN BOARD OF PHARMACY