Healthcare Provider Details

I. General information

NPI: 1881833184
Provider Name (Legal Business Name): WHITE BLUFF PRESCRIPTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 HWY 70 E
WHITE BLUFF TN
37187-9220
US

IV. Provider business mailing address

PO BOX 637
WHITE BLUFF TN
37187-0637
US

V. Phone/Fax

Practice location:
  • Phone: 615-797-5899
  • Fax: 615-797-5898
Mailing address:
  • Phone: 615-797-5899
  • Fax: 615-797-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number000004620
License Number StateTN

VIII. Authorized Official

Name: MARCEE MCCALLISTER
Title or Position: PARTNER
Credential:
Phone: 615-797-5899