Provider Demographics
NPI:1215176854
Name:PRUITTS DISCOUNT PHARMACY
Entity type:Organization
Organization Name:PRUITTS DISCOUNT PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:615-562-6337
Mailing Address - Street 1:811 DICKERSON PIKE STE C
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-5633
Mailing Address - Country:US
Mailing Address - Phone:615-562-6337
Mailing Address - Fax:615-369-8759
Practice Address - Street 1:811 DICKERSON PIKE STE C
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-5633
Practice Address - Country:US
Practice Address - Phone:615-562-6337
Practice Address - Fax:615-369-8759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TN50053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136079OtherPK
TN7483960001Medicare NSC