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Provider Information for 1497790786


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MIDDLE TENNESSEE PHARMACY SERVICES LLC

Organization Subpart: NO

NPI: 1497790786
Last Updated: 2008-06-18
Certification Date:

Details

NameValue
NPI1497790786
Enumeration Date2006-06-19
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: Mr. RUSS SPIVEY D.P.H
Title: Pharmacist In Charge
Phone: 9316849987
Mailing Address 336 S CANNON BLVD
SHELBYVILLE, TN 37160-3914
United States

Phone: 931-684-9987 | Fax:931-684-9995
 
Primary Practice Address 336 S CANNON BLVD
SHELBYVILLE, TN 37160-3914
United States

Phone: 931-684-9987 | Fax:931-684-9995
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)TN1455133TennCare
Other (non-Medicare)TN4135181BCBS TN DME
Other (non-Medicare)TN4138194BCBS TN HIT
MEDICAIDTN4438140
Other (non-Medicare)TN=========Tricare
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 3336C0004X - Pharmacy - Compounding PharmacyTN0000004147
No 3336L0003X - Pharmacy - Long Term Care PharmacyTN0000004147
No 3336S0011X - Pharmacy - Specialty PharmacyTN0000004147
No 3336H0001X - Pharmacy - Home Infusion Therapy PharmacyTN0000004147
Yes 332BP3500X - Durable Medical Equipment & Medical Supplies - Parenteral & Enteral NutritionTN0000004147