Healthcare Provider Details

I. General information

NPI: 1760860076
Provider Name (Legal Business Name): ENIGMA ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 11TH AVE S
NASHVILLE TN
37203-4021
US

IV. Provider business mailing address

226 11TH AVE S
NASHVILLE TN
37203-4021
US

V. Phone/Fax

Practice location:
  • Phone: 615-645-9680
  • Fax: 615-645-9782
Mailing address:
  • Phone: 615-645-9680
  • Fax: 615-645-9782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0214001984
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0000005742
License Number StateTN

VIII. Authorized Official

Name: TRACI POOLE
Title or Position: PRESIDENT/CEO
Credential: PHARM.D.
Phone: 615-645-9680