Healthcare Provider Details

I. General information

NPI: 1821054289
Provider Name (Legal Business Name): DUREN CLINICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 DEXTER L WOODS MEMORIAL BLVD
WAYNESBORO TN
38485-2416
US

IV. Provider business mailing address

215 DEXTER L WOODS MEMORIAL BLVD P. O. BOX 736
WAYNESBORO TN
38485-2416
US

V. Phone/Fax

Practice location:
  • Phone: 931-722-5466
  • Fax: 931-722-9495
Mailing address:
  • Phone: 931-722-5466
  • Fax: 931-722-9495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1195
License Number StateTN

VIII. Authorized Official

Name: MR. JERRY M. DUREN
Title or Position: OWNER
Credential: PHARM.D
Phone: 931-722-5466