Provider Demographics
NPI:1013400167
Name:BCP 1, LLC
Entity Type:Organization
Organization Name:BCP 1, LLC
Other - Org Name:C & C PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:731-285-0844
Mailing Address - Street 1:2490 PARR AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-2030
Mailing Address - Country:US
Mailing Address - Phone:731-285-0844
Mailing Address - Fax:
Practice Address - Street 1:2490 PARR AVE STE 9
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2030
Practice Address - Country:US
Practice Address - Phone:731-285-0844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:C & C PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy