Healthcare Provider Details

I. General information

NPI: 1851302434
Provider Name (Legal Business Name): PHARMACY HOME DELIVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 KEITH ST SW SUITE 1
CLEVELAND TN
37311-5868
US

IV. Provider business mailing address

PO BOX 3296
CLEVELAND TN
37320-3296
US

V. Phone/Fax

Practice location:
  • Phone: 423-614-6650
  • Fax: 423-614-6652
Mailing address:
  • Phone: 800-862-1456
  • Fax: 888-805-2406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number4219
License Number StateTN

VIII. Authorized Official

Name: H DON HICKS
Title or Position: CEO
Credential:
Phone: 800-862-1456