Provider Demographics
NPI:1447354758
Name:ATCHLEY DRUG CENTER INC
Entity type:Organization
Organization Name:ATCHLEY DRUG CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:423-639-5755
Mailing Address - Street 1:511 ASHERVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-4669
Mailing Address - Country:US
Mailing Address - Phone:423-639-5155
Mailing Address - Fax:423-639-2476
Practice Address - Street 1:511 ASHERVILLE HWY
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-4669
Practice Address - Country:US
Practice Address - Phone:423-639-5155
Practice Address - Fax:423-639-2476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN22809OtherBLUE CARE
TN1452790Medicaid
TN1452790Medicaid