=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881765402
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | P AND P PRESCRIPTION SHOP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 04/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 IMPERIAL BLVD STE 9
-----------------------------------------------------
City | HENDERSONVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37075-3479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-824-1216
-----------------------------------------------------
Fax | 615-264-3784
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 107 IMPERIAL BLVD STE 9
-----------------------------------------------------
City | HENDERSONVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37075-3479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-824-1216
-----------------------------------------------------
Fax | 615-264-3784
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RODNEY MCCORMICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-824-1216
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number | 1337
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------