NPI Code Detail JSON Logo

1396566238 NPI number — EAGLE DEN DISCOUNT DRUG, LLC

NPI Number: 1396566238
Health Care Provider/Practitioner: EAGLE DEN DISCOUNT DRUG, LLC

Information about “1396566238” NPI (EAGLE DEN DISCOUNT DRUG, LLC) exists in 1396566238 in HTML format HTML  |  1396566238 in plain Text format TXT  |  1396566238 in PDF (Portable Document Format) PDF  |  1396566238 in an XML format XML  formats.

NPI Number : 1396566238 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396566238",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "EAGLE DEN DISCOUNT DRUG, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "514 DEER TRACE WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SEYMOUR",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37865-6061",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "901-355-5556",
    "MailingAddressFaxNumber": "865-908-8864",
    "FirstLinePracticeLocationAddress": "11510 CHAPMAN HWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SEYMOUR",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37865-5044",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "865-299-4044",
    "PracticeLocationAddressFaxNumber": "865-299-4046",
    "EnumerationDate": "10/23/2024",
    "LastUpdateDate": "10/23/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BULLINGTON",
    "AuthorizedOfficialFirstName": "ROBERT",
    "AuthorizedOfficialMiddleName": "WAYNE",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PHARMD",
    "AuthorizedOfficialTelephoneNumber": "865-299-4044",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "3336L0003X",
        "TaxonomyName": "Long Term Care Pharmacy",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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