National Provider Identifier Database

FOUNTAIN PLAZA PHARMACY LLC
Specialty Pharmacy

A pharmacy that dispenses generally low volume and high cost medicinal preparations to patients who are undergoing intensive therapies for illnesses that are generally chronic, complex and potentially life threatening. Often these therapies require specialized delivery and administration.


Contact Information

FOUNTAIN PLAZA PHARMACY, LLC
2825 W ANDREW JOHNSON HWY
MORRISTOWN, TN37814
Phone: 423-307-5757
Fax: 423-307-5241
Website:
Specialty Taxonomy Code
* Specialty Pharmacy 3336S0011X
Community/Retail Pharmacy 3336C0003X
Compounding Pharmacy 3336C0004X
Home Infusion Therapy Pharmacy 3336H0001X
Mail Order Pharmacy 3336M0002X

* Indicates primary specialty

NPI Profile & details for FOUNTAIN PLAZA PHARMACY, LLC

NPI Number 1821362526
Legal business name
LBN
FOUNTAIN PLAZA PHARMACY, LLC
Authorized official JOSEPH HUNTSMAN - (PARTNER & CFO)
Entity Organization
Organization subpart No
Enumeration date 02/28/2012
Last updated 08/18/2025 - About 10 months ago
Sole proprietor1 Not specified
Identifiers
  • CO License #: OSP.0006973
  • GA License #: PHNR001097
  • IL License #: 054.020619
  • KY License #: TN1923
  • MO License #: 2018008256
  • MS License #: 14556
  • TN License #: 4998
  • AR Medicaid: 232282407
  • AZ Medicaid: 95213
  • CO Medicaid: 9000202940
  • IL Medicaid: 1821362526
  • IN Medicaid: 300047862
  • KY Medicaid: 7100373620
  • NC Medicaid: 574038
  • OH Medicaid: 431597
  • PA Medicaid: 103955980001
  • PA Medicaid: 7Z1164
  • SC Medicaid: 7Z1164
  • TN Medicaid: Q035892
  • UT Medicaid: 4067029
  • VA Medicaid: 2018228689
  • Other: 2134355 PK

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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