Provider Demographics
NPI:1093424129
Name:DOWN HOME RX LLC
Entity Type:Organization
Organization Name:DOWN HOME RX LLC
Other - Org Name:DOWN HOME PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:KRAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:865-993-4074
Mailing Address - Street 1:1034 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAN STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37708-4257
Mailing Address - Country:US
Mailing Address - Phone:865-993-4074
Mailing Address - Fax:865-993-4194
Practice Address - Street 1:1034 MAIN ST
Practice Address - Street 2:
Practice Address - City:BEAN STATION
Practice Address - State:TN
Practice Address - Zip Code:37708-4257
Practice Address - Country:US
Practice Address - Phone:865-993-4074
Practice Address - Fax:865-993-4194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-17
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ046113Medicaid