Kmart Pharmacy 3022

NPI #1912361619 in Bristol, Tennessee

Provider Information

NPI Number: 1912361619
Entity Type: Organization
Organization Name: Kmart Pharmacy 3022
Primary Specialty: Pharmacist
Enumeration Date: Apr 8, 2016
Last Updated: Apr 8, 2016

Practice Location

Address: 2854 W STATE ST
City: Bristol
State: Tennessee
ZIP Code: 37620-1711
Phone: (423) 968-7032

Authorized Official

Name: DR. CHARLES EDWIN ROBERTS II, PHARM.D
Title: PHARMACIST
Phone: (423) 968-7032

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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