Healthcare Provider Details

I. General information

NPI: 1518945765
Provider Name (Legal Business Name): VILLAGE DRUGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W KNIGHT ST
PORTLAND TN
37148-1415
US

IV. Provider business mailing address

100 W KNIGHT ST
PORTLAND TN
37148-1415
US

V. Phone/Fax

Practice location:
  • Phone: 615-325-9218
  • Fax: 615-325-7038
Mailing address:
  • Phone: 615-325-9218
  • Fax: 615-325-7038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5
License Number StateTN

VIII. Authorized Official

Name: LESTER STEVE BLEVINS
Title or Position: OWNER
Credential: RPH
Phone: 615-325-9218