Pharmacy Specialty Services

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

0000003619 Issued in TN

Legal business name

PHARMACY SPECIALTY SERVICES

Practice address

1301 N Roan St
Johnson City, TN 37601-3941

Phone

(423) 928-3130

Fax

(423) 928-2249

NPI assigned

Jan 2, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brian Bevins

Title

Owner

Phone

(423) 928-3130

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212624000000",
    "number": "1104001809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 N ROAN ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376013941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 N ROAN ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376013941",
            "telephone_number": "423-928-3130",
            "fax_number": "423-928-2249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMACY SPECIALTY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-02",
        "last_updated": "2008-06-05",
        "status": "A",
        "authorized_official_last_name": "BEVINS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-928-3130"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "TN",
            "license": "0000003619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "4440878",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thelia Jean Pettigrew, LPN
• Hannah Jo Pettit, PA-C
• Joshua Robert Pettit, PA
• Justin Pettit, PA
• Kylee Leann Pettit, PA
• Brad Alan Phelps, RPH
• Brandon Michael Phillips
• Jacob Elizabeth Phillips, BSW
• Olivia Blake Phillips
• Angela Phipps

• Compounding Pharmacy in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Compounding Pharmacy in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.