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General NPI Number Information
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NPI Number | 1851302434
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Entity Type | Organization
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Legal Business Name | PHARMACY HOME DELIVERY LLC
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 110 KEITH ST SW SUITE 1
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City | CLEVELAND
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State | TN
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Zip | 37311-5868
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Country | US
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Telephone | 423-614-6650
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Fax | 423-614-6652
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Provider Business Mailing Address
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Address Line | PO BOX 3296
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City | CLEVELAND
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State | TN
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Zip | 37320-3296
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Country | US
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Telephone | 800-862-1456
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Fax | 888-805-2406
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Authorized Official
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Title or Position | CEO
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Name | H DON HICKS
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Credential |
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Telephone | 800-862-1456
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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 | 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 #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 4219
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License Number State | TN
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