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General NPI Number Information
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NPI Number | 1649223165
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Entity Type | Organization
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Legal Business Name | INFINITY PHARMACY LLC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 1080 NEAL ST STE 100
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City | COOKEVILLE
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State | TN
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Zip | 38501-0942
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Country | US
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Telephone | 931-520-1001
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Fax | 931-520-1345
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Provider Business Mailing Address
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Address Line | 1080 NEAL ST STE 100
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City | COOKEVILLE
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State | TN
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Zip | 38501-0942
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Country | US
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Telephone | 931-520-1001
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Fax | 931-520-1345
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Authorized Official
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Title or Position | OWNER
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Name | MARK CASAL
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Credential | RPH
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Telephone | 931-520-1001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0000004275
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License Number State | TN
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