Healthcare Provider Details

I. General information

NPI: 1861403933
Provider Name (Legal Business Name): GAINESBORO RX CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HULL AVENUE
GAINESBORO TN
38562
US

IV. Provider business mailing address

75 E VETERANS DR. APT G202
COOKEVILLE TN
38501
US

V. Phone/Fax

Practice location:
  • Phone: 931-268-9919
  • Fax: 931-268-3840
Mailing address:
  • Phone: 931-268-9919
  • Fax: 931-268-3840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0000002154
License Number StateTN

VIII. Authorized Official

Name: MR. HEMAL PATEL
Title or Position: OWNER/PHARMACIST
Credential: RPH.
Phone: 931-268-9919