Healthcare Provider Details

I. General information

NPI: 1336005107
Provider Name (Legal Business Name): TRUEROOTS COMPOUNDING PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2025
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
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: 888-839-8750
Mailing address:
  • Phone: 615-375-6020
  • Fax: 888-839-8750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TODD OLDHAM
Title or Position: OWNER/PHARMACIST
Credential: PHARMD.
Phone: 615-375-6020