=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538799655
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROFESSIONAL ARTS PHARMACY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2020
-----------------------------------------------------
Last Update Date | 09/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 148 W CHURCH ST SUITE B
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-968-5474
-----------------------------------------------------
Fax | 731-798-5079
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 270 W CHURCH ST STE C
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38351-2077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-968-5474
-----------------------------------------------------
Fax | 731-968-5369
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SAMUEL D PACE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 731-614-4259
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------