Medical Mall Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2964 Issued in TN

Legal business name

MEDICAL MALL PHARMACY INC

Doing business as

Medical Mall Pharmacy

Practice address

1 Medical Park Blvd
Suite 106-E
Bristol, TN 37620-7430

Phone

(423) 844-2888

Fax

(423) 844-2891

NPI assigned

May 23, 2005

Organization subpart

No

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

Authorized official

Name

Kristine Hagee

Title

Pharmacy Systems Analyst

Phone

(423) 230-8432

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• MEDICAL MALL PHARMACY Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Wellmont Health System

  dba Holston Valley Medical Center

  • General Acute Care Hospital
  • Kingsport, TN
  • NPI 1487690400

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241049600000",
    "number": "1598768699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PARK BLVD STE 106",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376207430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PARK BLVD",
            "address_2": "SUITE 106-E",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376207430",
            "telephone_number": "423-844-2888",
            "fax_number": "423-844-2891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL MALL PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2009-04-30",
        "status": "A",
        "authorized_official_last_name": "HAGEE",
        "authorized_official_first_name": "KRISTINE",
        "authorized_official_title_or_position": "PHARMACY SYSTEMS ANALYST",
        "authorized_official_telephone_number": "423-230-8432"
    },
    "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": "2964",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008503257",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4428719",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICAL MALL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Med One of Tennessee PC
• Jan Showalter Medeiros, RPH
• Medexpress Urgent Care, PC - Tennessee
• Medical Education Assistance Corporation
• Medical Education Assistance Corporation (University Physicians Practice Group-Etsu Family Medicine Bristol)
• Mark Steven Mehlferber, PAC
• Alexander Melkonian, PHD
• Mitchell J. Mendrek, M.D.
• Timothy E Mercer, MD
• William H Messerschmidt, M.D.

• Community/Retail Pharmacy in Bristol, TN
• Providers in Bristol, 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 30, 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.