NPIMap

Organization Active NPI

Formulab LLC

  • Community/Retail Pharmacy
  • Knoxville, TN
National Provider Identifier
1174834758
Registry record updated May 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
128 Issued in TN
Legal business name
FORMULAB LLC
Practice address
5821 Walden Dr
Knoxville, TN 37919-6334
Phone
(865) 588-0689
Fax
(865) 588-0680
NPI assigned
Jun 29, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2011

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

Authorized official

Name
Scotty WyattNPI 1568780658
Title
Member
Phone
(865) 588-0689

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 128 TN Primary

Addresses

Primary practice location

5821 Walden Dr
Knoxville, TN 37919-6334

Mailing address

5821 Walden Dr
Knoxville, TN 37919-6334
Phone (865) 588-0689

Other identifiers 1

IdentifierTypeStateIssuer
4443420OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Community Pharmacy Doing business as

National Provider Directory

National Provider Directory

Locations

5821 Walden Dr
Knoxville, TN 37919
Phone (865) 588-0689

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1277769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305504000000",
    "number": "1174834758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5821 WALDEN DR",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379196334",
            "telephone_number": "865-588-0689",
            "fax_number": "865-588-0680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5821 WALDEN DR",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379196334",
            "telephone_number": "865-588-0689",
            "fax_number": "865-588-0680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORMULAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-29",
        "last_updated": "2011-05-16",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "SCOTTY",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "865-588-0689"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TN",
            "license": "128",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4443420",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 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.