NPIMap

Organization Active NPI

East Tennessee State University

Doing business as ETSU Charitable Pharmacy

  • Clinic Pharmacy
  • Johnson City, TN
National Provider Identifier
1154780716
Registry record updated Feb 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
5399 Issued in TN
Legal business name
EAST TENNESSEE STATE UNIVERSITY
Doing business as
ETSU Charitable Pharmacy
Practice address
2151 Century LN
Johnson City, TN 37604-4469
Phone
(423) 926-2500
Fax
(423) 926-5999
NPI assigned
Feb 11, 2016
Last updated
Feb 11, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2016

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

Authorized official

Name
David D Collins
Title
Cfo, VP Finance Admin
Phone
(423) 439-5884

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X 5399 TN Primary

Addresses

Primary practice location

2151 Century LN
Johnson City, TN 37604-4469

Mailing address

PO Box 70403
Johnson City, TN 37614-1703
Phone (423) 439-4071

Other names 1

  • ETSU Charitable Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Etsu Behavioral Health and Wellness Clinic20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1455148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455148800000",
    "number": "1154780716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70403",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376141703",
            "telephone_number": "423-439-4071",
            "fax_number": "423-439-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2151 CENTURY LN",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376044469",
            "telephone_number": "423-926-2500",
            "fax_number": "423-926-5999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TENNESSEE STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-11",
        "last_updated": "2016-02-11",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CFO, VP FINANCE ADMIN",
        "authorized_official_telephone_number": "423-439-5884"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "TN",
            "license": "5399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ETSU Charitable Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2016; 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.