MEDICARE: WHITE BLUFF DRUG CO

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	3283	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1770586901	OTHER	TN	NATIONAL PROVIDER NUMBER

General Provider Information

NPI Number	:	1265492037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE BLUFF DRUG CO

Provider Business Mailing Address
First Line	:	4514 HWY 70 E
Second Line	:	P O BOX 640
City	:	WHITE BLUFF
State	:	TN
Zip	:	37187-9219
Country	:	US
Telephone Number	:	615-797-3343
Fax Number	:	615-797-5250

Provider Business Practice Location Address
First Line	:	4514 HWY 70 E
Second Line	:
City	:	WHITE BLUFF
State	:	TN
Zip	:	37187-9219
Country	:	US
Telephone Number	:	615-797-3343
Fax Number	:	615-797-5250

Authorized Official
Title or Position	:	PHARMACIST OWNER
Name	:	DR. DAVID WILSON POWELL
Credential	:	DPH
Telephone Number	:	615-797-3362

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	08/22/2020

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Directions to “WHITE BLUFF DRUG CO ” Practice Location

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