Healthcare Provider Details

I. General information

NPI: 1629177555
Provider Name (Legal Business Name): COMMUNITY PHARMACY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W KINGSTON SPRINGS RD STE 103
KINGSTON SPRINGS TN
37082-9121
US

IV. Provider business mailing address

111 W KINGSTON SPRINGS RD STE 103
KINGSTON SPRINGS TN
37082-9121
US

V. Phone/Fax

Practice location:
  • Phone: 615-952-3690
  • Fax: 615-952-3692
Mailing address:
  • Phone: 615-952-3690
  • Fax: 615-952-3692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number4314
License Number StateTN

VIII. Authorized Official

Name: MARTY GENTRY
Title or Position: PARTNER
Credential: PHARM D
Phone: 615-446-5585