Healthcare Provider Details

I. General information

NPI: 1912928979
Provider Name (Legal Business Name): DAVIDSONS DISCOUNT DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HILLCREST DR
BYRDSTOWN TN
38549-2323
US

IV. Provider business mailing address

110 HILLCREST DR
BYRDSTOWN TN
38549-2323
US

V. Phone/Fax

Practice location:
  • Phone: 931-864-3166
  • Fax: 931-864-8166
Mailing address:
  • Phone: 931-864-3166
  • Fax: 931-864-8166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0000001971
License Number StateTN

VIII. Authorized Official

Name: KENDLE DAVDSON
Title or Position: OWNER
Credential: RPH
Phone: 931-864-3166