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General NPI Number Information
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NPI Number | 1245600618
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Entity Type | Organization
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Legal Business Name | PRUITT'S DISCOUNT PHARMACY, LLC
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 811 DICKERSON PIKE C
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City | NASHVILLE
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State | TN
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Zip | 37207-5632
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Country | US
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Telephone | 615-562-6337
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Fax | 615-369-8759
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Provider Business Mailing Address
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Address Line | 811 DICKERSON PIKE C
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City | NASHVILLE
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State | TN
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Zip | 37207-5632
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Country | US
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Telephone | 615-562-6337
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Fax | 615-369-8759
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHAWN DEGEORGE PRUITT SR.
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Credential | PHARM.D.
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Telephone | 615-562-6337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 11293
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 261QR1100X
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Taxonomy Name | Research Clinic/Center
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License Number | 11293
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 11293
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License Number State | TN
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