Organization Active NPI

Marcum'S Pharmacy, Inc

  • Pharmacy
  • Kingsport, TN
National Provider Identifier
1245315522
Registry record updated Aug 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
510 Issued in TN
Legal business name
MARCUM'S PHARMACY, INC
Practice address
902 Broad St
Kingsport, TN 37660-3815
Phone
(423) 246-6166
Fax
(423) 246-9259
NPI assigned
Oct 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2021

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

Authorized official

Name
Colton N Marcum, RPHNPI 1902243496
Title
Owner
Phone
(423) 246-6166

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 510 TN Primary

Addresses

Primary practice location

902 Broad St
Kingsport, TN 37660-3815

Mailing address

902 Broad St
Kingsport, TN 37660-3815
Phone (423) 246-6166

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120328000321 TN Part B Supplier - Mass Immunization (Roster Biller Only) 5991825549 Practice locations: Kingsport, TN
O20210824002927 TN Part B Supplier - Independent Clinical Laboratory 5991825549 Practice locations: Kingsport, TN

National Provider Directory

National Provider Directory

Locations

121 E Ravine Rd
Ste 100
Kingsport, TN 37660
Phone (423) 246-6166

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 5

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": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630281600000",
    "number": "1245315522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 BROAD ST",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603815",
            "telephone_number": "423-246-6166",
            "fax_number": "423-246-9259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 BROAD ST",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603815",
            "telephone_number": "423-246-6166",
            "fax_number": "423-246-9259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARCUM'S PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2021-08-30",
        "certification_date": "2021-08-30",
        "status": "A",
        "authorized_official_last_name": "MARCUM",
        "authorized_official_first_name": "COLTON",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-246-6166",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TN",
            "license": "510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.