OrganizationActive
Pharmacy Specialty Services
NPI 1104001809 · Compounding Pharmacy · Johnson City, TN
Provider details
- NPI number
- 1104001809
- Entity type
- Organization
- Primary specialty
- Compounding PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Brian Bevins, Owner(423) 928-3130
- License
- 0000003619 (TN)
Specialties & taxonomies
Suppliers
Profile Score
Detailed profile(88/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1301 N Roan St
Johnson City, TN 37601-3941
Phone: (423) 928-3130
Fax: (423) 928-2249
Street-level locationGet directions
Mailing address
1301 N Roan St
Johnson City, TN 37601-3941
Registry dates
- Enumerated
- 2008-01-02
- Last updated
- 2008-06-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.