Healthcare Provider Details

I. General information

NPI: 1386909547
Provider Name (Legal Business Name): PROMISECARE PHARMACY II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MAINSTREAM DR
NASHVILLE TN
37228-1208
US

IV. Provider business mailing address

501 MAINSTREAM DR
NASHVILLE TN
37228-1208
US

V. Phone/Fax

Practice location:
  • Phone: 615-299-8920
  • Fax: 877-323-9047
Mailing address:
  • Phone: 615-299-8920
  • Fax: 877-323-9047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5075
License Number StateTN

VIII. Authorized Official

Name: READUS SMITH
Title or Position: CEO/ CHAIRMAN/ OWNER
Credential:
Phone: 877-323-9067