Provider Demographics
NPI:1780695353
Name:P & S PHARMACY
Entity type:Organization
Organization Name:P & S PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIZZLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-246-8351
Mailing Address - Street 1:613 WATAUGA ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4429
Mailing Address - Country:US
Mailing Address - Phone:423-246-8351
Mailing Address - Fax:423-230-0832
Practice Address - Street 1:613 WATAUGA ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4429
Practice Address - Country:US
Practice Address - Phone:423-246-8351
Practice Address - Fax:423-230-0832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN00000005093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN97010572383Medicaid
4404149OtherNCPDP PROVIDER IDENTIFICATION NUMBER