1992947691 NPI number — F Z WEBB & SONS PHARMACY OF MCMINNVILLE LLC

Table of content: (NPI 1992947691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992947691 NPI number — F Z WEBB & SONS PHARMACY OF MCMINNVILLE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
F Z WEBB & SONS PHARMACY OF MCMINNVILLE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
F. Z. WEBB & SONS PHARMACY OF MCMINNVILLE LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992947691
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
835 SMITHVILLE HWY
Provider Second Line Business Mailing Address:
STE 25
Provider Business Mailing Address City Name:
MCMINNVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37110-1669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-474-9322
Provider Business Mailing Address Fax Number:
931-474-9324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
835 SMITHVILLE HWY
Provider Second Line Business Practice Location Address:
STE 25
Provider Business Practice Location Address City Name:
MCMINNVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37110-1669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-474-9322
Provider Business Practice Location Address Fax Number:
931-474-9324
Provider Enumeration Date:
03/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ROLLER
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER, PIC, AO
Authorized Official Telephone Number:
931-474-9322

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 4631 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1517160 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2119367 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com