MEDICARE: THE DRUG STORE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy	1937	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2090610	OTHER		PK

General Provider Information

NPI Number	:	1003837063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DRUG STORE INC

Provider Business Mailing Address
First Line	:	153 HERNDON DR
Second Line	:
City	:	BELLS
State	:	TN
Zip	:	38006-3688
Country	:	US
Telephone Number	:	731-663-2314
Fax Number	:	731-436-0011

Provider Business Practice Location Address
First Line	:	153 HERNDON DR
Second Line	:
City	:	BELLS
State	:	TN
Zip	:	38006-3688
Country	:	US
Telephone Number	:	731-663-2314
Fax Number	:	731-436-0011

Authorized Official
Title or Position	:	CLAIMS PROCESSOR
Name	:	CARIN BARNHILL
Credential	:
Telephone Number	:	731-663-2314

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	03/01/2017

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Directions to “THE DRUG STORE INC ” Practice Location

Language	Start Address	Practice Location

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