Provider Demographics
NPI:1124199146
Name:DOCTORS HOSPITAL PHARMACY INC
Entity Type:Organization
Organization Name:DOCTORS HOSPITAL PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIMER
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:423-586-6612
Mailing Address - Street 1:420 W MORRIS BLVD STE 160B
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2262
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 W MORRIS BLVD STE 160B
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2262
Practice Address - Country:US
Practice Address - Phone:423-586-6612
Practice Address - Fax:423-586-1431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336I0012X, 3336L0003X
TN12413336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1452927Medicaid
TN3519293Medicaid
4409644OtherOTHER ID NUMBER-COMMERCIAL NUMBER
TN0126540003OtherPALMETTO GBA