Organization
Pharmacy Specialty Services
Provider's NPPES record last updated: June 5, 2008
Overview
- Entity Type
- Organization
- NPI
- 1104001809
- Primary Specialty
- Pharmacy — Compounding Pharmacy
- Practice Location
- Johnson City, Tennessee
- Organization Subpart
- No
Federal Screening
NPISignal checked this NPI against federal exclusion sources. Results below are based on the NPI number itself — an identifier match, not a name match.
List of Excluded Individuals/Entities (LEIE)
HHS Office of Inspector General
No potential match was identified in NPISignal's indexed List of Excluded Individuals/Entities (LEIE) records as of 2026-09-10.
- Source data
- September 10, 2026
- Records indexed
- 84,001
- Screened
- Sep 17, 2026, 10:44 PM UTC
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
SAM.gov Exclusions
U.S. General Services Administration
SAM.gov Exclusions was not checked.
SAM.gov screening is not configured on this deployment. No SAM check has been performed.
- Screened
- Not checked
This is an NPI-based check only. NPISignal does not publish name-based exclusion matches on a provider profile. A shared or similar name is a lead that requires human review, not an identification, and this page is not the place to make one. Run a name-based screening below to see potential matches with the reasons for each.
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
Searches OIG LEIE and SAM.gov by name and reviews every potential match.
Specialties & Taxonomies
- Primary
Pharmacy
Compounding Pharmacy
Suppliers
A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner's Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice. A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice.
Taxonomy code 3336C0004X
Provider-Reported License Information
- Pharmacy (Tennessee)
- 0000003619
Practice Locations
Practice Location
1301 N Roan St
Johnson City, Tennessee 37601-3941
Phone: (423) 928-3130
Record Information
- Enumeration Date
- January 2, 2008
- Provider's NPPES Record Last Updated
- June 5, 2008
- NPISignal NPPES Dataset
- August 2026
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