Provider Demographics
NPI:1720491749
Name:LIFEPOINT PHARMACY
Entity type:Organization
Organization Name:LIFEPOINT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACITS. STAFF
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:615-225-8870
Mailing Address - Street 1:3163 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-7174
Mailing Address - Country:US
Mailing Address - Phone:615-225-8870
Mailing Address - Fax:
Practice Address - Street 1:3163 SOUTH CHURCH STREET
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37127
Practice Address - Country:US
Practice Address - Phone:615-225-8870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC005712332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1396013454Medicaid