NPIMap

Organization Active NPI

Medical Mall Pharmacy Inc

Doing business as Stone Drive Outpatient Pharmacy

  • Pharmacy
  • Kingsport, TN
National Provider Identifier
1316191349
Registry record updated Feb 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
4582 Issued in TN
Legal business name
MEDICAL MALL PHARMACY INC
Doing business as
Stone Drive Outpatient Pharmacy
Practice address
105 W Stone Dr
Suite 1-B
Kingsport, TN 37660-3256
Phone
(423) 224-3555
Fax
(423) 224-3560
NPI assigned
Nov 4, 2008
Last updated
Feb 20, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2009

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

Authorized official

Name
Carrie Sweet
Title
Director of Outpatient Pharmac
Phone
(423) 230-8435

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 4582 TN Primary

Addresses

Primary practice location

105 W Stone Dr
Suite 1-B
Kingsport, TN 37660-3256

Mailing address

105 W Stone Dr
Suite 1-B
Kingsport, TN 37660-3256

Other identifiers 1

IdentifierTypeStateIssuer
4442062OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Stone Drive Outpatient Pharmacy Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1225756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235088000000",
    "number": "1316191349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 W STONE DR",
            "address_2": "SUITE 1-B",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 W STONE DR",
            "address_2": "SUITE 1-B",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603256",
            "telephone_number": "423-224-3555",
            "fax_number": "423-224-3560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL MALL PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-04",
        "last_updated": "2009-02-20",
        "status": "A",
        "authorized_official_last_name": "SWEET",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_title_or_position": "DIRECTOR OF OUTPATIENT PHARMAC",
        "authorized_official_telephone_number": "423-230-8435"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TN",
            "license": "4582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4442062",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stone Drive Outpatient Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Feb 20, 2009; 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.