Healthcare Provider Details

I. General information

NPI: 1205872751
Provider Name (Legal Business Name): BLANE MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 DONELSON PKWY
DOVER TN
37058-3724
US

IV. Provider business mailing address

1307 DONELSON PKWY
DOVER TN
37058-3724
US

V. Phone/Fax

Practice location:
  • Phone: 931-232-0123
  • Fax: 931-232-1185
Mailing address:
  • Phone: 931-232-0123
  • Fax: 931-232-1185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number4231
License Number StateTN

VIII. Authorized Official

Name: MR. MARLIN LYNN BLANE
Title or Position: OWNER
Credential: PHARM D
Phone: 931-232-0123