Provider Demographics
NPI:1265492037
Name:WHITE BLUFF DRUG CO
Entity Type:Organization
Organization Name:WHITE BLUFF DRUG CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:615-797-3362
Mailing Address - Street 1:4514 HWY 70 E
Mailing Address - Street 2:P O BOX 640
Mailing Address - City:WHITE BLUFF
Mailing Address - State:TN
Mailing Address - Zip Code:37187-9219
Mailing Address - Country:US
Mailing Address - Phone:615-797-3343
Mailing Address - Fax:615-797-5250
Practice Address - Street 1:4514 HWY 70 E
Practice Address - Street 2:
Practice Address - City:WHITE BLUFF
Practice Address - State:TN
Practice Address - Zip Code:37187-9219
Practice Address - Country:US
Practice Address - Phone:615-797-3343
Practice Address - Fax:615-797-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3283333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1770586901OtherNATIONAL PROVIDER NUMBER