PEYTLIV INC
NPI 1184114613
Pharmacy - Community/Retail Pharmacy in New Tazewell, TN

Q: What is Peytliv Inc's NPI number?

The NPI number for Peytliv Inc is 1184114613. It was assigned to this organization in the NPPES registry on May 10, 2018. The provider is doing business as Crater City Pharmacy.

Q: What is Peytliv Inc's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Q: When was this NPI record last updated?

The NPPES record for Peytliv Inc was last updated on September 19, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 10, 2018

915 N BROAD ST, NEW TAZEWELL, TN 37825(423) 626-5511 Get Directions Write a Review

NPPES record last updated: September 19, 2025. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Sep 19, 2025, Oct 16, 2023, Oct 15, 2023 and 4 more (7 updates tracked since 2018).

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About Peytliv Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PEYTLIV INC (NPI 1184114613), doing business as Crater City Pharmacy, is a healthcare organization registered as a community/retail pharmacy in New Tazewell, Tennessee and active in the NPI registry since May 2018. The organization maintains a secondary practice location in Middlesboro and lists Detra Robertson, Pharmacist/owner, as its authorized official.

NPPES Registry Identity

NPI1184114613

Entity TypeOrganization

Primary Taxonomy3336C0003X

Legal Business NamePEYTLIV INC

Location Address915 N BROAD STNew Tazewell, TN 37825-6633

Mailing Address1841 N 25th StMiddlesboro, KY 40965-1853 · (606) 248-9330 · Fax (606) 248-9337

Phone(423) 626-5511

Organization SubpartNo

Authorized OfficialDetra RobertsonPharmacist/owner · (606) 248-9330

Enumeration DateMay 10, 2018

Last NPPES UpdateSeptember 19, 20257 updates tracked since enumeration

NPPES CertifiedOctober 16, 2023

✔ NPI 1184114613 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers

Taxonomy Code3336C0003X

License✔ Licensed in KY · PO7862

Definition

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.

Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X

Also ListedPharmacyTaxonomy 333600000X

915 N BROAD ST, New Tazewell, TN 37825

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Other Names 1

Doing Business AsCrater City Pharmacy

Secondary Practice Location 1

Location 11841 N 25th StMiddlesboro, KY 40965-1853 · Phone (606) 248-9330 · Fax (606) 248-9337

Other Identifiers 1

Other2177440Pk

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Medica, Moda Health Plan, Inc..Insurance ›

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANDREA BROOKE MIRACLE PHARM. D

Pharmacist