Healthcare Provider Details

I. General information

NPI: 1386787315
Provider Name (Legal Business Name): MITCHUM DRUG COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SPRING & FRONT STS
ERIN TN
37061
US

IV. Provider business mailing address

PO BOX 227 18 SPRING ST
ERIN TN
37061-0227
US

V. Phone/Fax

Practice location:
  • Phone: 931-289-4231
  • Fax: 931-289-4230
Mailing address:
  • Phone: 931-289-4231
  • Fax: 931-289-4230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number358
License Number StateTN

VIII. Authorized Official

Name: MR. CARLISLE WEBB MITCHUM III
Title or Position: PRESIDENT-PHARMACIST
Credential:
Phone: 931-289-4231