Healthcare Provider Details

I. General information

NPI: 1629244900
Provider Name (Legal Business Name): COMMUNITY DRUG CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

862 ROBINSON RD
OLD HICKORY TN
37138-3331
US

IV. Provider business mailing address

PO BOX 1267
GOODLETTSVILLE TN
37070-1267
US

V. Phone/Fax

Practice location:
  • Phone: 615-847-5527
  • Fax: 615-847-2858
Mailing address:
  • Phone: 615-847-5527
  • Fax: 615-847-2858

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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number4507
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4441250
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP PROVIDER IDENTIFICATION NUMBER

VIII. Authorized Official

Name: JOHN EVANS
Title or Position: PRESIDENT
Credential: D. PH.
Phone: 615-847-5527