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General NPI Number Information
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NPI Number | 1396566238
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Entity Type | Organization
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Legal Business Name | EAGLE DEN DISCOUNT DRUG, LLC
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 11510 CHAPMAN HWY
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City | SEYMOUR
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State | TN
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Zip | 37865-5044
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Country | US
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Telephone | 865-299-4044
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Fax | 865-299-4046
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Provider Business Mailing Address
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Address Line | 514 DEER TRACE WAY
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City | SEYMOUR
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State | TN
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Zip | 37865-6061
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Country | US
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Telephone | 901-355-5556
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Fax | 865-908-8864
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT WAYNE BULLINGTON
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Credential | PHARMD
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Telephone | 865-299-4044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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