MEDICARE: CITY DRUG STORE OF PARSONS, 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	333600000X	Pharmacy	1065	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	:	1710979976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY DRUG STORE OF PARSONS, INC

Provider Business Mailing Address
First Line	:	18 W MAIN ST
Second Line	:
City	:	PARSONS
State	:	TN
Zip	:	38363-2012
Country	:	US
Telephone Number	:	731-847-6337
Fax Number	:	731-847-6178

Provider Business Practice Location Address
First Line	:	18 W MAIN ST
Second Line	:
City	:	PARSONS
State	:	TN
Zip	:	38363-2012
Country	:	US
Telephone Number	:	731-847-6337
Fax Number	:	731-847-6178

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	KIMOTHY PHILLIPS
Credential	:	PHARMD DPH
Telephone Number	:	731-847-6337

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	03/02/2026

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