Provider Demographics
NPI:1164100053
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:BUSINESS DEVELOPMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:DOTY
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-520-1567
Mailing Address - Street 1:300 STONECREST BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5689
Mailing Address - Country:US
Mailing Address - Phone:615-459-5335
Mailing Address - Fax:615-459-5349
Practice Address - Street 1:300 STONECREST BLVD STE 130
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5689
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 INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-10
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy