P H Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH28718 Issued in FL

Legal business name

P H PHARMACY LLC

Doing business as

P. H. Pharmacy, LLC

Practice address

110 Keith St SW
Ste 3
Cleveland, TN 37311-5868

Phone

(423) 614-6610

Fax

(888) 805-2406

NPI assigned

Feb 22, 2010

Last updated

Mar 27, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Hunter Hicks

Title

Ceo

Phone

(770) 845-9470

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• P. H. Pharmacy, LLC Doing business as

Locations

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

{
    "created_epoch": "1266796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490572800000",
    "number": "1265754030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 KEITH ST SW",
            "address_2": "SUITE 3",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373115868",
            "telephone_number": "423-614-6610",
            "fax_number": "888-805-2406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 KEITH ST SW",
            "address_2": "STE 3",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373115868",
            "telephone_number": "423-614-6610",
            "fax_number": "888-805-2406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P H PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-22",
        "last_updated": "2017-03-27",
        "status": "A",
        "authorized_official_last_name": "HICKS",
        "authorized_official_first_name": "HUNTER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-845-9470"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": "PHNR000227",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TN",
            "license": "4732",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH28718",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265754030",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2123882",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "P. H. Pharmacy, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Juie M Owen
• Mark Winfield Owen, APRN
• Kaitlin Elizabeth Ramsey Owens
• Sherree Owens
• Ernest N Oyler Jr., DDS, FAGD
• Enelys Paez, DDS
• Sushil Pakhrin, DMD
• Tynesha Palmer
• Pamela Jones-Singleton
• Paragon Medical Enteprises Inc

• Community/Retail Pharmacy in Cleveland, TN
• Providers in Cleveland, 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 Mar 27, 2017; 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.