Healthcare Provider Details

I. General information

NPI: 1962542969
Provider Name (Legal Business Name): CITY DRUG COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 E MAIN ST
HUMBOLDT TN
38343-2901
US

IV. Provider business mailing address

1511 E MAIN ST
HUMBOLDT TN
38343-2901
US

V. Phone/Fax

Practice location:
  • Phone: 731-784-2724
  • Fax: 731-784-5801
Mailing address:
  • Phone: 731-784-2724
  • Fax: 731-784-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4022
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number4022
License Number StateTN

VIII. Authorized Official

Name: MR. WILLIAM DAVID ROE JR.
Title or Position: PHARMACIST,PRESIDENT
Credential: PHARM D
Phone: 731-784-2724