Provider Demographics
NPI:1063549863
Name:SEYMOUR PHARMACY INC.
Entity type:Organization
Organization Name:SEYMOUR PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:865-577-0471
Mailing Address - Street 1:10721 CHAPMAN HWY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-4765
Mailing Address - Country:US
Mailing Address - Phone:865-577-0471
Mailing Address - Fax:
Practice Address - Street 1:10721 CHAPMAN HWY
Practice Address - Street 2:SUITE 6
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-4765
Practice Address - Country:US
Practice Address - Phone:865-577-0471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2280183500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1452075Medicaid
TN4426640OtherNABP NO.
TN0685990001Medicare NSC