Healthcare Provider Details

I. General information

NPI: 1699255620
Provider Name (Legal Business Name): PHARMHOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W MAIN ST
WAVERLY TN
37185-1513
US

IV. Provider business mailing address

PO BOX 207
WAVERLY TN
37185-0207
US

V. Phone/Fax

Practice location:
  • Phone: 931-299-7181
  • Fax: 931-299-7241
Mailing address:
  • Phone: 931-299-7181
  • Fax: 931-299-7241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number6443
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDON TRULL
Title or Position: OWNER/PHARMACIST
Credential: PHARM. D.
Phone: 931-299-7181