Healthcare Provider Details

I. General information

NPI: 1336691856
Provider Name (Legal Business Name): NEIGHBORHOOD PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1954 SAINT JOHN AVE STE B
DYERSBURG TN
38024-2199
US

IV. Provider business mailing address

1954 SAINT JOHN AVE STE B
DYERSBURG TN
38024-2199
US

V. Phone/Fax

Practice location:
  • Phone: 731-259-0404
  • Fax: 731-259-0406
Mailing address:
  • Phone: 731-676-4534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5879
License Number StateTN

VIII. Authorized Official

Name: BRIAN WRIGHT
Title or Position: PRESIDENT
Credential:
Phone: 731-676-4534