Provider Demographics
NPI:1124198205
Name:DISNEY PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:DISNEY PHARMACY SERVICES INC
Other - Org Name:VAUGHN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:DISNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:865-947-1581
Mailing Address - Street 1:2141 W EMORY RD
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-3704
Mailing Address - Country:US
Mailing Address - Phone:865-947-1581
Mailing Address - Fax:865-947-4353
Practice Address - Street 1:2141 W EMORY RD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3704
Practice Address - Country:US
Practice Address - Phone:865-947-1581
Practice Address - Fax:865-947-4353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2015-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN19453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2090600OtherPK