Provider Demographics
NPI:1194705756
Name:REEVES DRUG STORE, INC.
Entity type:Organization
Organization Name:REEVES DRUG STORE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARDEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:HERITAGE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-534-1118
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-0346
Mailing Address - Country:US
Mailing Address - Phone:931-363-2561
Mailing Address - Fax:931-363-3284
Practice Address - Street 1:125 N 1ST ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-3214
Practice Address - Country:US
Practice Address - Phone:931-363-2561
Practice Address - Fax:931-424-3284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
TN00000010793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ035645Medicaid
2095989OtherPK
TN4410988Medicaid
TN4410988Medicaid