FOUNTAIN PLAZA PHARMACY, LLC; NPI #1821362526

Contact Information

FOUNTAIN PLAZA PHARMACY, LLC

2825 W ANDREW JOHNSON HWY
MORRISTOWN, TN 37814

Phone: 423-307-5757
Fax: 423-307-5241
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Specialty Pharmacy	3336S0011X	58	Medical Supply Company with Pharmacist
Community/Retail Pharmacy	3336C0003X	58	Medical Supply Company with Pharmacist
Compounding Pharmacy	3336C0004X	58	Medical Supply Company with Pharmacist
Home Infusion Therapy Pharmacy	3336H0001X	58	Medical Supply Company with Pharmacist
Mail Order Pharmacy	3336M0002X	58	Medical Supply Company with Pharmacist

Indicates primary specialty

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NPI Profile & details for FOUNTAIN PLAZA PHARMACY, LLC

NPI # 1821362526

LBN Legal business name FOUNTAIN PLAZA PHARMACY, LLC

Authorized official JOSEPH HUNTSMAN - (PARTNER & CFO)

Entity Organization

Organization subpart ¹ No

Enumeration date 02/28/2012

Last updated 08/18/2025 - About 10 months ago

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 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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