Provider Demographics
NPI:1962892349
Name:RURAL PHYSICIAN PARTNERS PHARMACY
Entity type:Organization
Organization Name:RURAL PHYSICIAN PARTNERS PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-579-9999
Mailing Address - Street 1:361 MALLORY STATION RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2832
Mailing Address - Country:US
Mailing Address - Phone:615-739-6501
Mailing Address - Fax:615-739-6245
Practice Address - Street 1:361 MALLORY STATION RD STE 108
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8254
Practice Address - Country:US
Practice Address - Phone:615-739-6501
Practice Address - Fax:615-739-6245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336M0002X
TN55163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149872OtherPK