Provider Demographics
NPI:1386787315
Name:MITCHUM DRUG COMPANY INC
Entity type:Organization
Organization Name:MITCHUM DRUG COMPANY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLISLE
Authorized Official - Middle Name:WEBB
Authorized Official - Last Name:MITCHUM
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:931-289-4231
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:18 SPRING ST
Mailing Address - City:ERIN
Mailing Address - State:TN
Mailing Address - Zip Code:37061-0227
Mailing Address - Country:US
Mailing Address - Phone:931-289-4231
Mailing Address - Fax:931-289-4230
Practice Address - Street 1:SPRING & FRONT STS
Practice Address - Street 2:
Practice Address - City:ERIN
Practice Address - State:TN
Practice Address - Zip Code:37061
Practice Address - Country:US
Practice Address - Phone:931-289-4231
Practice Address - Fax:931-289-4230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4402878OtherNABP
TN3545373Medicaid
TN3059807OtherBLUE CROSS BLUE SHIELD TN
TN3545373Medicaid