Healthcare Provider Details

I. General information

NPI: 1962313775
Provider Name (Legal Business Name): CARTERS SB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 ELDAD RD
FAYETTEVILLE TN
37334-7005
US

IV. Provider business mailing address

10394 TIDWELL RD
BON AQUA TN
37025-1567
US

V. Phone/Fax

Practice location:
  • Phone: 931-438-0760
  • Fax: 931-433-1169
Mailing address:
  • Phone: 601-946-1826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JIMMY TUCKER
Title or Position: CEO / PRESIDENT / OWNER
Credential: RPH
Phone: 601-946-1826