Healthcare Provider Details

I. General information

NPI: 1205828662
Provider Name (Legal Business Name): COMMUNITY PHARMACY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2005
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7723 CLEARVIEW CHURCH LN
LYLES TN
37098-1609
US

IV. Provider business mailing address

7723 CLEARVIEW CHURCH LN
LYLES TN
37098-1609
US

V. Phone/Fax

Practice location:
  • Phone: 931-670-6035
  • Fax:
Mailing address:
  • Phone: 931-670-6035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1530
License Number StateTN

VIII. Authorized Official

Name: MARTHA SHEPARD
Title or Position: PHARMACIST
Credential: D.PH.
Phone: 931-670-6035