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General NPI Number Information
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NPI Number | 1336691856
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Entity Type | Organization
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Legal Business Name | NEIGHBORHOOD PHARMACY LLC
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Dates
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Enumeration Date | 11/01/2016
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Last Update Date | 12/20/2016
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Provider Practice Location Address
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Address Line | 1954 SAINT JOHN AVE STE B
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City | DYERSBURG
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State | TN
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Zip | 38024-2199
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Country | US
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Telephone | 731-259-0404
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Fax | 731-259-0406
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Provider Business Mailing Address
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Address Line | 1954 SAINT JOHN AVE STE B
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City | DYERSBURG
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State | TN
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Zip | 38024-2199
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Country | US
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Telephone | 731-676-4534
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN WRIGHT
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Credential |
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Telephone | 731-676-4534
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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 |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 5879
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License Number State | TN
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