Provider Demographics
NPI:1265457394
Name:CHURCH HILL DRUG STORE
Entity Type:Organization
Organization Name:CHURCH HILL DRUG STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHARMOCIST
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-357-7441
Mailing Address - Street 1:104 MAIN ST. EAST
Mailing Address - Street 2:
Mailing Address - City:CHURCH HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37642
Mailing Address - Country:US
Mailing Address - Phone:423-357-7441
Mailing Address - Fax:423-357-1276
Practice Address - Street 1:104 MAIN ST E
Practice Address - Street 2:
Practice Address - City:CHURCH HILL
Practice Address - State:TN
Practice Address - Zip Code:37642
Practice Address - Country:US
Practice Address - Phone:423-357-7441
Practice Address - Fax:423-357-1276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty