Provider Demographics
NPI:1437566445
Name:ESCUE FAMILY PRESCRIPTION SHOP
Entity Type:Organization
Organization Name:ESCUE FAMILY PRESCRIPTION SHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:CAYE
Authorized Official - Last Name:ESCUE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:615-672-7954
Mailing Address - Street 1:614A HIGHWAY 76
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-9354
Mailing Address - Country:US
Mailing Address - Phone:615-672-7954
Mailing Address - Fax:615-672-7955
Practice Address - Street 1:614A HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-9354
Practice Address - Country:US
Practice Address - Phone:615-672-7954
Practice Address - Fax:615-672-7955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000054173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy