Provider Demographics
NPI:1346251998
Name:RIGGS DRUG STORE
Entity Type:Organization
Organization Name:RIGGS DRUG STORE
Other - Org Name:RIGGS DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACY/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FANNON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:423-562-5235
Mailing Address - Street 1:PO BOX 1407
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-1407
Mailing Address - Country:US
Mailing Address - Phone:423-562-5235
Mailing Address - Fax:423-566-2212
Practice Address - Street 1:502 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3400
Practice Address - Country:US
Practice Address - Phone:423-562-5235
Practice Address - Fax:423-563-7242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN5933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2094817OtherPK
TN3518937Medicaid
TN3518937Medicaid