Provider Demographics
NPI:1912928979
Name:DAVIDSONS DISCOUNT DRUGS INC
Entity type:Organization
Organization Name:DAVIDSONS DISCOUNT DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENDLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVDSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:931-864-3166
Mailing Address - Street 1:110 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:BYRDSTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38549-2323
Mailing Address - Country:US
Mailing Address - Phone:931-864-3166
Mailing Address - Fax:931-864-8166
Practice Address - Street 1:110 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:BYRDSTOWN
Practice Address - State:TN
Practice Address - Zip Code:38549-2323
Practice Address - Country:US
Practice Address - Phone:931-864-3166
Practice Address - Fax:931-864-8166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000019713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4424305OtherNCPDP PROVIDER IDENTIFICATION NUMBER
4916590001Medicare NSC