Provider Demographics
NPI:1063583276
Name:DONELSON DRUG MART
Entity type:Organization
Organization Name:DONELSON DRUG MART
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:615-883-8515
Mailing Address - Street 1:2608 LEBANON PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-2403
Mailing Address - Country:US
Mailing Address - Phone:615-883-8515
Mailing Address - Fax:615-883-8553
Practice Address - Street 1:2608 LEBANON PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-2403
Practice Address - Country:US
Practice Address - Phone:615-883-8515
Practice Address - Fax:615-883-8553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0776190001Medicare NSC