Healthcare Provider Details

I. General information

NPI: 1821645201
Provider Name (Legal Business Name): SC PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 CLINTON AVE
SPRING CITY TN
37381-4037
US

IV. Provider business mailing address

PO BOX 515
SPRING CITY TN
37381-0515
US

V. Phone/Fax

Practice location:
  • Phone: 423-365-6351
  • Fax: 423-365-4877
Mailing address:
  • Phone: 423-365-6351
  • Fax: 423-365-4877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierQ051561
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer

VIII. Authorized Official

Name: JONATHAN SETH ZIMMERMAN
Title or Position: OWNER/PHARMACIST
Credential: PHARMD
Phone: 423-365-6351