Provider Demographics
NPI:1477715928
Name:DURENS HEALTHCARE LLC
Entity Type:Organization
Organization Name:DURENS HEALTHCARE LLC
Other - Org Name:DURENS HEALTH MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUREN
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:931-722-4183
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:TN
Mailing Address - Zip Code:37096-0629
Mailing Address - Country:US
Mailing Address - Phone:931-589-2146
Mailing Address - Fax:931-589-2890
Practice Address - Street 1:119 S MILL ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:TN
Practice Address - Zip Code:37096-6457
Practice Address - Country:US
Practice Address - Phone:931-589-2146
Practice Address - Fax:931-589-2890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
TN000045173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2095417OtherPK
6363020001Medicare NSC