Provider Demographics
NPI:1003837063
Name:THE DRUG STORE INC
Entity Type:Organization
Organization Name:THE DRUG STORE INC
Other - Org Name:THE DRUG STORE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLAIMS PROCESSOR
Authorized Official - Prefix:
Authorized Official - First Name:CARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-663-2314
Mailing Address - Street 1:153 HERNDON DR
Mailing Address - Street 2:
Mailing Address - City:BELLS
Mailing Address - State:TN
Mailing Address - Zip Code:38006-3688
Mailing Address - Country:US
Mailing Address - Phone:731-663-2314
Mailing Address - Fax:731-436-0011
Practice Address - Street 1:153 HERNDON DR
Practice Address - Street 2:
Practice Address - City:BELLS
Practice Address - State:TN
Practice Address - Zip Code:38006-3688
Practice Address - Country:US
Practice Address - Phone:731-663-2314
Practice Address - Fax:731-436-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN19373336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9449397Medicaid
2090610OtherPK
2090610OtherPK