Healthcare Provider Details

I. General information

NPI: 1588600076
Provider Name (Legal Business Name): COOKEVILLE DISCOUNT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N WASHINGTON AVE STE 130
COOKEVILLE TN
38501-2603
US

IV. Provider business mailing address

315 N WASHINGTON AVE STE 130
COOKEVILLE TN
38501-2603
US

V. Phone/Fax

Practice location:
  • Phone: 931-528-4634
  • Fax: 931-372-1631
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0000003488
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER CRANFORD
Title or Position: PHARM D
Credential:
Phone: 931-528-4634