Provider Demographics
NPI:1417223330
Name:EDDIES DRUG STORE LLC
Entity Type:Organization
Organization Name:EDDIES DRUG STORE LLC
Other - Org Name:EDDIE'S DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-286-9079
Mailing Address - Street 1:1240 FOX MEADOWS BLVD
Mailing Address - Street 2:STE #3
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-6928
Mailing Address - Country:US
Mailing Address - Phone:865-286-9079
Mailing Address - Fax:865-286-9016
Practice Address - Street 1:1240 FOX MEADOWS BLVD STE 3
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-6928
Practice Address - Country:US
Practice Address - Phone:865-286-9079
Practice Address - Fax:865-286-9016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-25
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN50033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4444953OtherNCPDP PROVIDER IDENTIFICATION NUMBER