Healthcare Provider Details

I. General information

NPI: 1407201304
Provider Name (Legal Business Name): RUTHERFORD DRUG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2994 S CHURCH ST
MURFREESBORO TN
37127-8351
US

IV. Provider business mailing address

2994 S CHURCH ST
MURFREESBORO TN
37127-8351
US

V. Phone/Fax

Practice location:
  • Phone: 615-895-1641
  • Fax: 615-895-1601
Mailing address:
  • Phone: 615-895-1641
  • Fax: 615-895-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number4441
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHAD MILLS
Title or Position: PHARMACIST
Credential:
Phone: 615-895-1641