Provider Demographics
NPI:1427654623
Name:BCP1, LLC LONG TERM CARE
Entity type:Organization
Organization Name:BCP1, LLC LONG TERM CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:BARRETT
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-513-0882
Mailing Address - Street 1:2490 PARR AVE STE 9B
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-2029
Mailing Address - Country:US
Mailing Address - Phone:731-285-0844
Mailing Address - Fax:
Practice Address - Street 1:2490 PARR AVE STE 9
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2030
Practice Address - Country:US
Practice Address - Phone:731-285-0844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BCP1, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy