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NPI Code Detail

MEDICARE: FAMILY MEDICAL CENTER PHARMACY INC

MEDICARE: FAMILY MEDICAL CENTER PHARMACY 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
1333600000XPharmacy1125TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14400646OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1932292117
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY MEDICAL CENTER PHARMACY INC
Provider Business Mailing Address
First Line : 300 N CONGRESS BLVD
Second Line :
City : SMITHVILLE
State : TN
Zip : 37166-2704
Country : US
Telephone Number : 615-597-4988
Fax Number : 615-597-5321
Provider Business Practice Location Address
First Line : 300 N CONGRESS BLVD
Second Line :
City : SMITHVILLE
State : TN
Zip : 37166-2704
Country : US
Telephone Number : 615-597-4988
Fax Number : 615-597-5321
Authorized Official
Title or Position : PRESIDENT
Name : BLAKE DAUGHTRY
Credential :
Telephone Number : 615-597-4988
Provider Enumeration Date : 10/02/2006
Last Update Date : 12/01/2011

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Directions to “FAMILY MEDICAL CENTER PHARMACY INC ” Practice Location

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