Provider Demographics
NPI:1265646038
Name:CITY PHARMACY INC
Entity Type:Organization
Organization Name:CITY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDDIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:423-638-8154
Mailing Address - Street 1:113 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-5603
Mailing Address - Country:US
Mailing Address - Phone:423-638-8154
Mailing Address - Fax:423-638-2084
Practice Address - Street 1:113 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-5603
Practice Address - Country:US
Practice Address - Phone:423-638-8154
Practice Address - Fax:423-638-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH008583183500000X
TN0000000295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ACO393734Medicare UPIN