Provider Demographics
NPI:1285747527
Name:CARLA STAGGS
Entity type:Organization
Organization Name:CARLA STAGGS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:B
Authorized Official - Last Name:STAGGS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:931-724-9197
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:313 HWY 13 SOUTH
Mailing Address - City:COLLINWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:38450-0096
Mailing Address - Country:US
Mailing Address - Phone:931-724-9197
Mailing Address - Fax:931-724-5381
Practice Address - Street 1:313 HWY 13 SOUTH
Practice Address - Street 2:
Practice Address - City:COLLINWOOD
Practice Address - State:TN
Practice Address - Zip Code:38450
Practice Address - Country:US
Practice Address - Phone:931-724-9197
Practice Address - Fax:931-724-5381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2179OtherSTATE PHARMACY BOARD
TN113600Medicaid
TN2179OtherSTATE PHARMACY BOARD