Healthcare Provider Details

I. General information

NPI: 1043225675
Provider Name (Legal Business Name): LORETTO DRUGS L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 CHURCH ST
LORETTO TN
38469-2143
US

IV. Provider business mailing address

PO BOX 278
LORETTO TN
38469-0278
US

V. Phone/Fax

Practice location:
  • Phone: 931-853-5910
  • Fax: 931-853-5930
Mailing address:
  • Phone:
  • Fax:

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 Number3933
License Number StateTN

VIII. Authorized Official

Name: TIMOTHY WAYNE
Title or Position: PIC
Credential:
Phone: 931-853-5920