Healthcare Provider Details

I. General information

NPI: 1134117146
Provider Name (Legal Business Name): DEBERRY DRUGS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 MULBERRY AVE
SELMER TN
38375
US

IV. Provider business mailing address

834 MULBERRY AVE
SELMER TN
38375-2334
US

V. Phone/Fax

Practice location:
  • Phone: 731-645-6100
  • Fax: 731-645-4333
Mailing address:
  • Phone: 731-645-6100
  • Fax: 731-645-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2087
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LAUREN RICKMAN
Title or Position: BOOK KEEPER/CPHT
Credential:
Phone: 731-645-6100