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NPI Code Detail

MEDICARE: DISNEY PHARMACY SERVICES INC

MEDICARE: DISNEY PHARMACY SERVICES 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
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy1945TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12090600OTHERPK

General Provider Information

NPI Number : 1124198205
Entity Type Code : Organization
Provider Name (Legal Business Name) : DISNEY PHARMACY SERVICES INC
Provider Business Mailing Address
First Line : 2141 W EMORY RD
Second Line :
City : POWELL
State : TN
Zip : 37849-3704
Country : US
Telephone Number : 865-947-1581
Fax Number : 865-947-4353
Provider Business Practice Location Address
First Line : 2141 W EMORY RD
Second Line :
City : POWELL
State : TN
Zip : 37849-3704
Country : US
Telephone Number : 865-947-1581
Fax Number : 865-947-4353
Authorized Official
Title or Position : OWNER,PIC,AO
Name : DWIGHT DISNEY
Credential : RPH
Telephone Number : 865-947-1581
Provider Enumeration Date : 11/08/2006
Last Update Date : 06/27/2015

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Directions to “DISNEY PHARMACY SERVICES INC ” Practice Location

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