Maynardville Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

3435 Issued in TN

Legal business name

MAYNARDVILLE PHARMACY INC

Practice address

4221 Maynardville Hwy
Maynardville, TN 37807-3555

Phone

(865) 992-9455

Fax

(865) 992-7979

NPI assigned

Jul 22, 2006

Organization subpart

No

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

Authorized official

Name

Rajendraprasad Venigalla

Title

Secretary

Phone

(347) 528-8893

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Okie's Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in TN2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 2

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

• Christopher Byrd

  • Pharmacist
  • Maynardville, TN
  • NPI 1538605498
  NPD (past)
• Michelle Leach, D.PH.,PIC.

  • Pharmacist
  • Maynardville, TN
  • NPI 1417254723
  NPD (past)

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586736000000",
    "number": "1396766366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4221 MAYNARDVILLE HWY",
            "city": "MAYNARDVILLE",
            "state": "TN",
            "postal_code": "378073555",
            "telephone_number": "865-992-9455",
            "fax_number": "865-992-7979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4221 MAYNARDVILLE HWY",
            "city": "MAYNARDVILLE",
            "state": "TN",
            "postal_code": "378073555",
            "telephone_number": "865-992-9455",
            "fax_number": "865-992-7979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYNARDVILLE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2020-04-13",
        "certification_date": "2020-04-13",
        "status": "A",
        "authorized_official_last_name": "VENIGALLA",
        "authorized_official_first_name": "RAJENDRAPRASAD",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "347-528-8893"
    },
    "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": "3435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2123620",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q033563",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Okie's Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Okie's Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Phoebe Marker, MS, CCC-SLP
• Rene Suzanne Martin, OTD, OTR/L
• Christie Layne Mase, APRN-FNP-C
• Amanda Loy Mason, R.N.
• Maynardville Drug LLC
• Natasha Dawn McBee
• Laura McCall, MS CCC-SLP
• Abigail McCarter, CNA
• Cathy Jean McClure, CERT MAST SOC WORKER
• Erin McConocha, MPH

• Community/Retail Pharmacy in Maynardville, TN
• Providers in Maynardville, 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 Apr 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.