Provider Demographics
NPI:1962530444
Name:CHURCH HILL DRUG STORE INC.
Entity type:Organization
Organization Name:CHURCH HILL DRUG STORE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:423-357-7441
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:CHURCH HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37642
Mailing Address - Country:US
Mailing Address - Phone:423-357-7441
Mailing Address - Fax:423-357-1276
Practice Address - Street 1:104 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:CHURCH HILL
Practice Address - State:TN
Practice Address - Zip Code:37642
Practice Address - Country:US
Practice Address - Phone:423-357-4034
Practice Address - Fax:423-357-1276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1193340001Medicare NSC