Healthcare Provider Details

I. General information

NPI: 1356402168
Provider Name (Legal Business Name): THE PRESCRIPTION SHOP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 MARKET ST
RED BOILING SPRINGS TN
37150-2271
US

IV. Provider business mailing address

126 MARKET ST
RED BOILING SPRINGS TN
37150-2271
US

V. Phone/Fax

Practice location:
  • Phone: 615-699-2509
  • Fax: 615-699-4139
Mailing address:
  • Phone: 615-699-2509
  • Fax: 615-699-4139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1030
License Number StateTN

VIII. Authorized Official

Name: DEVIN RUSSELL
Title or Position: OWNER
Credential:
Phone: 615-699-2509