Healthcare Provider Details

I. General information

NPI: 1265492037
Provider Name (Legal Business Name): WHITE BLUFF DRUG CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4514 HWY 70 E
WHITE BLUFF TN
37187-9219
US

IV. Provider business mailing address

4514 HWY 70 E P O BOX 640
WHITE BLUFF TN
37187-9219
US

V. Phone/Fax

Practice location:
  • Phone: 615-797-3343
  • Fax: 615-797-5250
Mailing address:
  • Phone: 615-797-3343
  • Fax: 615-797-5250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number3283
License Number StateTN

VIII. Authorized Official

Name: DR. DAVID WILSON POWELL
Title or Position: PHARMACIST OWNER
Credential: DPH
Phone: 615-797-3362