Provider Demographics
NPI:1053355362
Name:SMYRNA DRUG LP
Entity type:Organization
Organization Name:SMYRNA DRUG LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-459-3411
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-0041
Mailing Address - Country:US
Mailing Address - Phone:615-459-3411
Mailing Address - Fax:615-355-0629
Practice Address - Street 1:269 S LOWRY ST
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-3007
Practice Address - Country:US
Practice Address - Phone:615-459-3411
Practice Address - Fax:615-355-0629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN11283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4413059OtherNCPDP PROVIDER IDENTIFICATION NUMBER
4196120001Medicare NSC