Provider Demographics
NPI:1134117146
Name:DEBERRY DRUGS INC.
Entity Type:Organization
Organization Name:DEBERRY DRUGS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOK KEEPER/CPHT
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-645-6100
Mailing Address - Street 1:834 MULBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-2334
Mailing Address - Country:US
Mailing Address - Phone:731-645-6100
Mailing Address - Fax:731-645-4333
Practice Address - Street 1:834 MULBERRY AVE
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375
Practice Address - Country:US
Practice Address - Phone:731-645-6100
Practice Address - Fax:731-645-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2087333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9449564Medicaid
TN1134117146OtherNPI
TN4425357OtherNABP