Provider Demographics
NPI:1336691856
Name:NEIGHBORHOOD PHARMACY LLC
Entity Type:Organization
Organization Name:NEIGHBORHOOD PHARMACY LLC
Other - Org Name:NEIGHBORHOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-676-4534
Mailing Address - Street 1:1954 SAINT JOHN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-2199
Mailing Address - Country:US
Mailing Address - Phone:731-676-4534
Mailing Address - Fax:
Practice Address - Street 1:1954 SAINT JOHN AVE STE B
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2199
Practice Address - Country:US
Practice Address - Phone:731-259-0404
Practice Address - Fax:731-259-0406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5879333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2165911OtherPK