=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679040281
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NUTRITIONAL PHARMACY SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2018
-----------------------------------------------------
Last Update Date | 12/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1838 ELM HILL PIKE STE 117
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37210-3726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-538-1212
-----------------------------------------------------
Fax | 615-457-3527
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 290521
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37229-0521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-249-8099
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | CHRISTOPHER POWERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-405-4507
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336H0001X
-----------------------------------------------------
Taxonomy Name | Home Infusion Therapy Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------