MEDICARE: PHARMACISTS HOME MEDICAL LLC

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	332BX2000X	Oxygen Equipment & Supplies (DME)	332BX2000X	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3125115	OTHER	TN	BLUE CROSS BLUE SHEILD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3125115	OTHER	TN	TN CARE SELECT

General Provider Information

NPI Number	:	1184654303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACISTS HOME MEDICAL LLC

Provider Business Mailing Address
First Line	:	461 N SPRING ST
Second Line	:
City	:	SPARTA
State	:	TN
Zip	:	38583-1328
Country	:	US
Telephone Number	:	931-836-6387
Fax Number	:	931-836-1052

Provider Business Practice Location Address
First Line	:	461 N SPRING ST
Second Line	:
City	:	SPARTA
State	:	TN
Zip	:	38583-1328
Country	:	US
Telephone Number	:	931-836-6387
Fax Number	:	931-836-1052

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SAMUEL THOMAS ARMES JR.
Credential	:
Telephone Number	:	931-836-6387

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	04/07/2011

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Directions to “PHARMACISTS HOME MEDICAL LLC ” Practice Location

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