Healthcare Provider Details

I. General information

NPI: 1225502438
Provider Name (Legal Business Name): COMMUNITY PHARMACY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 HIGHWAY 70 E
DICKSON TN
37055-2034
US

IV. Provider business mailing address

104 HIGHWAY 70 E
DICKSON TN
37055-2034
US

V. Phone/Fax

Practice location:
  • Phone: 615-446-8396
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4260
Identifier TypeOTHER
Identifier StateTN
Identifier IssuerSTATE LICENSE

VIII. Authorized Official

Name: ANGELA WOOD
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 615-375-1602