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General NPI Number Information
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NPI Number | 1689279945
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Entity Type | Organization
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Legal Business Name | CENTRAL DRUG STORE PLLC
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Dates
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Enumeration Date | 12/03/2020
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 239 W SUMMER ST
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City | GREENEVILLE
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State | TN
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Zip | 37743-4925
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Country | US
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Telephone | 423-638-4711
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Fax | 423-638-3311
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Provider Business Mailing Address
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Address Line | 239 W SUMMER ST
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City | GREENEVILLE
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State | TN
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Zip | 37743-4925
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Country | US
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Telephone | 423-638-4711
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Fax | 423-638-3311
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Authorized Official
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Title or Position | OWNER
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Name | CYNTHIA B FISHER
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Credential | DPH
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Telephone | 423-638-4711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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