Provider Demographics
NPI:1962144949
Name:PRUITT'S PHARMACY, LLC IN ANTIOCH
Entity type:Organization
Organization Name:PRUITT'S PHARMACY, LLC IN ANTIOCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:615-562-6337
Mailing Address - Street 1:811 DICKERSON PIKE STE C
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-5633
Mailing Address - Country:US
Mailing Address - Phone:615-562-6337
Mailing Address - Fax:
Practice Address - Street 1:2510 MURFREESBORO PIKE STE 9
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-3621
Practice Address - Country:US
Practice Address - Phone:615-562-6337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRUITT'S DISCOUNT PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy