Mountain Valley Rx 05 Inc
Community/Retail Pharmacy
153 E Broadway Blvd, Ste 103, Jefferson City
Tennessee, 37760-2517
865-471-5111 865-471-5199
Mountain Valley Rx 05 Inc is a Community/Retail Pharmacy in Jefferson City, Tennessee. It is located at 153 E Broadway Blvd, Ste 103, Jefferson City and it's customer support contact number is 865-471-5111. The authorized person of Mountain Valley Rx 05 Inc is Beau Kisabeth who is Manager of the pharmacy and his contact number is 865-388-3211. Active license number of Mountain Valley Rx 05 Inc is 3918 for Community/Retail Pharmacy in Tennessee.
Mountain Valley Rx 05 Inc is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
Pharmacy Details:
Mountain Valley Rx 05 Inc type, location, contact phone number and fax are as below. Patients can directly walkin to the pharmacy or can call on the below given customer support phone number for enquiries.
| Name: | Mountain Valley Rx 05 Inc |
| Type: | Community/Retail Pharmacy |
| Location: | 153 E Broadway Blvd, Ste 103, Jefferson City,
Tennessee, 37760-2517 |
| Phone: | 865-471-5111 |
| Fax: | 865-471-5199 |
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints of this pharmacy is as below. Person's position and contact details are also mentioned below.
| Name: | Beau Kisabeth |
| Position: | Manager |
| Contact Number: | 865-388-3211 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details of given pharmacy are as mentioned below.
| NPI Number: | 1043364490 |
| NPI Enumeration Date: | 23 Jan, 2007 |
| NPI Last Update On: | 30 Mar, 2010 |
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Mountain Valley Rx 05 Inc are as mentioned below.
| Specialization | License Number | State | Status | |
| Community/Retail Pharmacy | 3918 | Tennessee | Primary | |
| Durable Medical Equipment & Medical Supplies | | | Secondary | |
Other Medical Identifiers:
Other legacy medical identifiers of the pharmacy such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 4437364 | Other | | Ncpdp Provider Identification Number |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | Po Box 385,
Dandridge, Tennessee |
| Zip: | 37725-0385 |
| Phone Number: | 865-475-9969 |
| Fax Number: | 865-475-9901 |
Patients can reach Mountain Valley Rx 05 Inc at
153 E Broadway Blvd, Ste 103, Jefferson City, Tennessee or can
call on customer care at 865-471-5111.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 December, 2025.