Organization Active NPI

Pharmacy Home Care of East Tennessee, Inc

  • Long Term Care Pharmacy
  • Cleveland, TN
National Provider Identifier
1710220918
Registry record updated Jul 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
PHARMACY HOME CARE OF EAST TENNESSEE, INC
Practice address
120 23Rd St NW
Cleveland, TN 37311-3845
Phone
(423) 790-1221
NPI assigned
Apr 5, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2026

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

Authorized official

Name
Jeffry H Wolfenden, RPH
Title
President
Phone
(423) 790-7336

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X TN Primary

Addresses

Primary practice location

120 23Rd St NW
Cleveland, TN 37311-3845

Mailing address

PO Box 2607
Cleveland, TN 37320-2607
Phone (423) 790-7336

Other identifiers 3

IdentifierTypeStateIssuer
Q032865MedicaidTN
4445854OtherTNNABP
5186OtherTNSTATE LICENSE BOARD OF PHARMACY

Other names 1

  • Pharmacy Home Care of East Tennessee Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160318000979 TN Part B Supplier - Mass Immunization (Roster Biller Only) 1153628193 Practice locations: Cleveland, TN

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2216834Pharmacy Home Care of East Tennessee120 23Rd Street NW, Cleveland, TN 37311Certificate of waiverMar 15, 2027

National Provider Directory

National Provider Directory

Locations

120 23rd St NW
Cleveland, TN 37311
Phone (423) 472-6482

Practitioners & affiliated clinicians

Practitioners 2

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": "1365120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785196800000",
    "number": "1710220918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2607",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373202607",
            "telephone_number": "423-790-7336",
            "fax_number": "423-790-7338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 23RD ST NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373113845",
            "telephone_number": "423-790-1221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMACY HOME CARE OF EAST TENNESSEE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-05",
        "last_updated": "2026-07-28",
        "certification_date": "2026-07-28",
        "status": "A",
        "authorized_official_last_name": "WOLFENDEN",
        "authorized_official_first_name": "JEFFRY",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "423-790-7336",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q032865",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "4445854",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE BOARD OF PHARMACY",
            "identifier": "5186",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pharmacy Home Care of East Tennessee",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cleveland, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2026; 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.