MEDICARE: VILLAGE DRUGS

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	5	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4412324	OTHER	TN	NABP

General Provider Information

NPI Number	:	1518945765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE DRUGS

Provider Business Mailing Address
First Line	:	100 W KNIGHT ST
Second Line	:
City	:	PORTLAND
State	:	TN
Zip	:	37148-1415
Country	:	US
Telephone Number	:	615-325-9218
Fax Number	:	615-325-7038

Provider Business Practice Location Address
First Line	:	100 W KNIGHT ST
Second Line	:
City	:	PORTLAND
State	:	TN
Zip	:	37148-1415
Country	:	US
Telephone Number	:	615-325-9218
Fax Number	:	615-325-7038

Authorized Official
Title or Position	:	OWNER
Name	:	LESTER STEVE BLEVINS
Credential	:	RPH
Telephone Number	:	615-325-9218

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	03/07/2023

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Directions to “VILLAGE DRUGS ” Practice Location

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