Healthcare Provider Details

I. General information

NPI: 1639057375
Provider Name (Legal Business Name): TRUEROOTS COMPOUNDING PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 HIGHWAY 70 E
DICKSON TN
37055-2108
US

IV. Provider business mailing address

695 HIGHWAY 70 E
DICKSON TN
37055-2108
US

V. Phone/Fax

Practice location:
  • Phone: 615-375-6020
  • Fax:
Mailing address:
  • Phone: 615-375-6020
  • 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:

VIII. Authorized Official

Name: DR. TODD OLDHAM
Title or Position: OWNER/PHARMACIST
Credential: PHARMD.
Phone: 615-202-6444