Provider Demographics
NPI:1033992243
Name:DYER STATION PHARMACY, LLC
Entity Type:Organization
Organization Name:DYER STATION PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:731-692-3578
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:TN
Mailing Address - Zip Code:38330-0265
Mailing Address - Country:US
Mailing Address - Phone:731-692-3578
Mailing Address - Fax:731-692-4219
Practice Address - Street 1:137 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:TN
Practice Address - Zip Code:38330-1815
Practice Address - Country:US
Practice Address - Phone:731-692-3578
Practice Address - Fax:731-692-4219
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DYER STATION PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy