MEDICARE: RENEGAR DRUG STORE

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	183500000X	Pharmacist	3868	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

General Provider Information

NPI Number	:	1144256538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEGAR DRUG STORE

Provider Business Mailing Address
First Line	:	629 N MAIN ST
Second Line	:
City	:	SHELBYVILLE
State	:	TN
Zip	:	37160-3235
Country	:	US
Telephone Number	:	931-684-1933
Fax Number	:	931-684-8739

Provider Business Practice Location Address
First Line	:	629 N MAIN ST
Second Line	:
City	:	SHELBYVILLE
State	:	TN
Zip	:	37160-3235
Country	:	US
Telephone Number	:	931-684-1933
Fax Number	:	931-684-8739

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	BARRY CHILDERS
Credential	:	D.P.H.
Telephone Number	:	931-684-1933

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	08/22/2020

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Directions to “RENEGAR DRUG STORE ” Practice Location

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