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General NPI Number Information
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NPI Number | 1720145717
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL CARE SERVICES OF WEST TN INC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/09/2019
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Provider Practice Location Address
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Address Line | 1997 HIGHWAY 51 S
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City | COVINGTON
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State | TN
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Zip | 38019-3630
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Country | US
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Telephone | 901-475-3586
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Fax | 901-313-1153
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Provider Business Mailing Address
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Address Line | 1997 HIGHWAY 51 S
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City | COVINGTON
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State | TN
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Zip | 38019-3630
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Country | US
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Telephone | 901-475-3586
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Fax | 901-313-1153
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Authorized Official
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Title or Position | CONTROLLER
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Name | TOM GRIFFIN
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Credential |
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Telephone | 901-622-1688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 189
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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