Provider Information for 1760783641
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CAVALIER PHARMACY LLC
Other Names:Doing Business As:CAVALIER PHARMACYOrganization Subpart: NO
NPI: 1760783641
Last Updated: 2023-03-31
Certification Date: 2023-03-31
Certification Date: 2023-03-31
Details
| Name | Value | ||||||||||||||||||||
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| NPI | 1760783641 | ||||||||||||||||||||
| Enumeration Date | 2010-11-09 | ||||||||||||||||||||
| NPI Type | NPI-2 Organization | ||||||||||||||||||||
| Status | Active | ||||||||||||||||||||
| Authorized Official Information | Name: DEREK HOLYFIELD Pharm. D Title: Managing Member Phone: 7316923578 | ||||||||||||||||||||
| Mailing Address | 8 N CAVALIER DR SUITE A ALAMO, TN 38001-6468 United States Phone: 731-696-4000 | Fax:731-696-4050 | ||||||||||||||||||||
| Primary Practice Address | 8 N CAVALIER DR SUITE A ALAMO, TN 38001-6468 United States Phone: 731-696-4000 | Fax:731-696-4050 | ||||||||||||||||||||
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