Provider Demographics
NPI:1144576836
Name:COMMUNITY PHARMACY OF SMYRNA LLC
Entity Type:Organization
Organization Name:COMMUNITY PHARMACY OF SMYRNA LLC
Other - Org Name:CUSTOMHEALTH PHARMACY NASHVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER CUSTOM HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-857-2871
Mailing Address - Street 1:300 STONECREST BLVD
Mailing Address - Street 2:STE 130
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5688
Mailing Address - Country:US
Mailing Address - Phone:615-459-3007
Mailing Address - Fax:615-459-5349
Practice Address - Street 1:300 STONECREST BLVD
Practice Address - Street 2:STE 130
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5688
Practice Address - Country:US
Practice Address - Phone:615-459-5335
Practice Address - Fax:615-459-5349
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUSTOM HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-31
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN50623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158521OtherPK