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General NPI Number Information
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NPI Number | 1013400167
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Entity Type | Organization
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Legal Business Name | BCP 1, LLC
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 2490 PARR AVE STE 9
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City | DYERSBURG
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State | TN
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Zip | 38024-2030
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Country | US
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Telephone | 731-285-0844
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Fax |
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Provider Business Mailing Address
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Address Line | 2490 PARR AVE STE 9
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City | DYERSBURG
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State | TN
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Zip | 38024-2030
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Country | US
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Telephone | 731-285-0844
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. MARK BROOKS
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Credential | PHARMD
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Telephone | 731-285-0844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State | TN
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