Provider Demographics
NPI:1073806154
Name:XPRESS PHARMACY OF CLAY COUNTY
Entity Type:Organization
Organization Name:XPRESS PHARMACY OF CLAY COUNTY
Other - Org Name:CLAY COUNTY XPRESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:L
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:931-243-3784
Mailing Address - Street 1:PO BOX 334
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TN
Mailing Address - Zip Code:38551-0334
Mailing Address - Country:US
Mailing Address - Phone:931-243-3784
Mailing Address - Fax:931-243-3785
Practice Address - Street 1:651 S. BROWN ST.
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TN
Practice Address - Zip Code:38551
Practice Address - Country:US
Practice Address - Phone:931-243-3784
Practice Address - Fax:931-243-3785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-23
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN48683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4444333OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TN6630070001Medicare NSC