Provider Demographics
NPI:1063027258
Name:ASPIRE PHARMACY LLC
Entity type:Organization
Organization Name:ASPIRE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPOS-RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-622-0968
Mailing Address - Street 1:907 RIVERGATE PKWY # E9
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2324
Mailing Address - Country:US
Mailing Address - Phone:615-622-0968
Mailing Address - Fax:615-656-5610
Practice Address - Street 1:907 RIVERGATE PKWY # E9
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2324
Practice Address - Country:US
Practice Address - Phone:615-622-0968
Practice Address - Fax:615-656-5610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ063763Medicaid