Healthcare Provider Details

I. General information

NPI: 1053355362
Provider Name (Legal Business Name): SMYRNA DRUG LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 S LOWRY ST
SMYRNA TN
37167-3007
US

IV. Provider business mailing address

PO BOX 41
SMYRNA TN
37167-0041
US

V. Phone/Fax

Practice location:
  • Phone: 615-459-3411
  • Fax: 615-355-0629
Mailing address:
  • Phone: 615-459-3411
  • Fax: 615-355-0629

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 Number1128
License Number StateTN

VIII. Authorized Official

Name: MARY COLE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 615-459-3411