Healthcare Provider Details

I. General information

NPI: 1376879767
Provider Name (Legal Business Name): B&B PHARMACY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5407 MAIN ST
SPRING HILL TN
37174-4412
US

IV. Provider business mailing address

5407 MAIN ST
SPRING HILL TN
37174-4412
US

V. Phone/Fax

Practice location:
  • Phone: 931-451-7785
  • Fax: 931-451-7786
Mailing address:
  • Phone: 931-451-7785
  • Fax: 931-451-7786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number4707
License Number StateTN

VII. Legacy identifiers

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

# 1
Identifier103G738380
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer
# 2
Identifier2122387
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: AHMAD ADHAMI
Title or Position: PHARM.D.
Credential:
Phone: 615-554-2841