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General NPI Number Information
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NPI Number | 1497790786
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Entity Type | Organization
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Legal Business Name | MIDDLE TENNESSEE PHARMACY SERVICES LLC
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 336 S CANNON BLVD
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City | SHELBYVILLE
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State | TN
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Zip | 37160-3914
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Country | US
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Telephone | 931-684-9987
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Fax | 931-684-9995
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Provider Business Mailing Address
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Address Line | 336 S CANNON BLVD
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City | SHELBYVILLE
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State | TN
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Zip | 37160-3914
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Country | US
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Telephone | 931-684-9987
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Fax | 931-684-9995
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MR. RUSS SPIVEY
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Credential | D.P.H
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Telephone | 931-684-9987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 0000004147
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 0000004147
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 0000004147
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | 0000004147
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 0000004147
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License Number State | TN
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