Healthcare Provider Details

I. General information

NPI: 1457387649
Provider Name (Legal Business Name): SCPG TENNESSEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6361 HIGHWAY 41A
PLEASANT VIEW TN
37146
US

IV. Provider business mailing address

PO BOX 34407, PMB 53760
LITTLE ROCK AR
72203-4420
US

V. Phone/Fax

Practice location:
  • Phone: 615-746-8432
  • Fax: 615-746-3784
Mailing address:
  • Phone: 870-761-0980
  • Fax: 615-746-3784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number109
License Number StateTN

VIII. Authorized Official

Name: UMAR FAROOQ
Title or Position: PRESIDENT
Credential:
Phone: 501-392-8680