Mulberry Street Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

TN4431 Issued in TN

Legal business name

MULBERRY STREET PHARMACY LLC

Doing business as

MULBERRY STREET PHARMACY LLC

Practice address

916 Mulberry St
Loudon, TN 37774-1311

Phone

(865) 458-4586

Fax

(865) 458-4545

NPI assigned

Aug 29, 2007

Organization subpart

No

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

Authorized official

Name

Joesph Ratledge, PHRMD

Title

Pic

Phone

(865) 458-4586

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MULBERRY STREET PHARMACY LLC Doing business as

Locations

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

{
    "created_epoch": "1188345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316044800000",
    "number": "1134313554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "916 MULBERRY ST",
            "city": "LOUDON",
            "state": "TN",
            "postal_code": "377741311",
            "telephone_number": "865-458-4586",
            "fax_number": "865-458-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 MULBERRY ST",
            "city": "LOUDON",
            "state": "TN",
            "postal_code": "377741311",
            "telephone_number": "865-458-4586",
            "fax_number": "865-458-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MULBERRY STREET PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-29",
        "last_updated": "2011-09-15",
        "status": "A",
        "authorized_official_last_name": "RATLEDGE",
        "authorized_official_first_name": "JOESPH",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "865-458-4586",
        "authorized_official_credential": "PHRMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TN",
            "license": "TN4431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4440602",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MULBERRY STREET PHARMACY LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Loudon, TN
• Providers in Loudon, TN by specialty
• Community/Retail Pharmacy in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2011; 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.