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NPI Code Detail

MEDICARE: DUREN CLINICAL SERVICES, LLC

MEDICARE: DUREN CLINICAL SERVICES, 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
13336C0003XCommunity/Retail Pharmacy1195TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24078454OTHERTNTENNCARE SELECT

General Provider Information

NPI Number : 1821054289
Entity Type Code : Organization
Provider Name (Legal Business Name) : DUREN CLINICAL SERVICES, LLC
Provider Business Mailing Address
First Line : 215 DEXTER L WOODS MEMORIAL BLVD
Second Line : P. O. BOX 736
City : WAYNESBORO
State : TN
Zip : 38485-2416
Country : US
Telephone Number : 931-722-5466
Fax Number : 931-722-9495
Provider Business Practice Location Address
First Line : 215 DEXTER L WOODS MEMORIAL BLVD
Second Line :
City : WAYNESBORO
State : TN
Zip : 38485-2416
Country : US
Telephone Number : 931-722-5466
Fax Number : 931-722-9495
Authorized Official
Title or Position : OWNER
Name : MR. JERRY M. DUREN
Credential : PHARM.D
Telephone Number : 931-722-5466
Provider Enumeration Date : 04/25/2006
Last Update Date : 05/19/2021

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1407132947 — ANGELINE AGNES CASTEEL C.PH.T
Practice Location Address:
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