MEDICARE: MCMINNVILLE DRUG CENTER 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	00000145	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4415318	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275530891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCMINNVILLE DRUG CENTER INC

Provider Business Mailing Address
First Line	:	1500 SPARTA ST
Second Line	:
City	:	MCMINNVILLE
State	:	TN
Zip	:	37110-1317
Country	:	US
Telephone Number	:	931-473-4471
Fax Number	:	931-473-2217

Provider Business Practice Location Address
First Line	:	1500 SPARTA ST
Second Line	:
City	:	MCMINNVILLE
State	:	TN
Zip	:	37110-1317
Country	:	US
Telephone Number	:	931-473-4471
Fax Number	:	931-473-2217

Authorized Official
Title or Position	:	OWNER PHARMACIST
Name	:	CHARLES MARSH
Credential	:
Telephone Number	:	931-473-4471

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	05/25/2011

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