Healthcare Provider Details

I. General information

NPI: 1649223165
Provider Name (Legal Business Name): INFINITY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 NEAL ST STE 100
COOKEVILLE TN
38501-0942
US

IV. Provider business mailing address

1080 NEAL ST STE 100
COOKEVILLE TN
38501-0942
US

V. Phone/Fax

Practice location:
  • Phone: 931-520-1001
  • Fax: 931-520-1345
Mailing address:
  • Phone: 931-520-1001
  • Fax: 931-520-1345

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 Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0000004275
License Number StateTN

VIII. Authorized Official

Name: MARK CASAL
Title or Position: OWNER
Credential: RPH
Phone: 931-520-1001