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General NPI Number Information
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NPI Number | 1144256538
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Entity Type | Organization
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Legal Business Name | RENEGAR DRUG STORE
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 629 N MAIN ST
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City | SHELBYVILLE
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State | TN
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Zip | 37160-3235
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Country | US
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Telephone | 931-684-1933
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Fax | 931-684-8739
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Provider Business Mailing Address
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Address Line | 629 N MAIN ST
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City | SHELBYVILLE
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State | TN
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Zip | 37160-3235
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Country | US
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Telephone | 931-684-1933
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Fax | 931-684-8739
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | BARRY CHILDERS
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Credential | D.P.H.
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Telephone | 931-684-1933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 3868
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License Number State | TN
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