Provider Demographics
NPI:1699796664
Name:STATE OF TENNESSEE STATE F & A PAYROLL
Entity type:Organization
Organization Name:STATE OF TENNESSEE STATE F & A PAYROLL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:STATE DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:CALITA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MPH
Authorized Official - Phone:615-253-2311
Mailing Address - Street 1:710 HART LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37216-2649
Mailing Address - Country:US
Mailing Address - Phone:615-650-7071
Mailing Address - Fax:615-226-4378
Practice Address - Street 1:710 HART LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37216-2649
Practice Address - Country:US
Practice Address - Phone:615-650-7071
Practice Address - Fax:615-226-4378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000002413336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2092037OtherPK