MEDICARE: LOTT FAMILY PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	6176	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2175300	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548773245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTT FAMILY PHARMACY LLC

Provider Business Mailing Address
First Line	:	PO BOX 1053
Second Line	:
City	:	SELMER
State	:	TN
Zip	:	38375-1053
Country	:	US
Telephone Number	:	731-645-5556
Fax Number	:	731-645-4420

Provider Business Practice Location Address
First Line	:	844 MULBERRY AVE
Second Line	:
City	:	SELMER
State	:	TN
Zip	:	38375-2334
Country	:	US
Telephone Number	:	731-645-5556
Fax Number	:	731-645-4420

Authorized Official
Title or Position	:	PIC
Name	:	JESSE LOTT
Credential	:
Telephone Number	:	731-645-5556

Provider Enumeration Date	:	11/16/2017
Last Update Date	:	03/05/2026

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Directions to “LOTT FAMILY PHARMACY LLC ” Practice Location

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