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General NPI Number Information
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NPI Number | 1043687379
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Entity Type | Organization
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Legal Business Name | FIRST PHARMACY SERVICES OF COUNTRY VILLAGE
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Dates
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Enumeration Date | 08/21/2015
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Last Update Date | 08/21/2015
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Provider Practice Location Address
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Address Line | 8130 COUNTRY VILLAGE DR
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City | CORDOVA
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State | TN
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Zip | 38016-2087
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Country | US
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Telephone | 901-590-3069
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 47
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City | POPE
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State | MS
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Zip | 38658-0047
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DENISE PRATT
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Credential |
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Telephone | 901-590-3069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 0000005606
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License Number State | TN
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