Healthcare Provider Details

I. General information

NPI: 1144256538
Provider Name (Legal Business Name): RENEGAR DRUG STORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 N MAIN ST
SHELBYVILLE TN
37160-3235
US

IV. Provider business mailing address

629 N MAIN ST
SHELBYVILLE TN
37160-3235
US

V. Phone/Fax

Practice location:
  • Phone: 931-684-1933
  • Fax: 931-684-8739
Mailing address:
  • Phone: 931-684-1933
  • Fax: 931-684-8739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3868
License Number StateTN

VIII. Authorized Official

Name: BARRY CHILDERS
Title or Position: OWNER/PHARMACIST
Credential: D.P.H.
Phone: 931-684-1933