Provider Demographics
NPI:1477856656
Name:DAYTON DRUG AND WELLNESS LLC
Entity Type:Organization
Organization Name:DAYTON DRUG AND WELLNESS LLC
Other - Org Name:DAYTON DRUG AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:BERNICE
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:423-775-5511
Mailing Address - Street 1:PO BOX 1045
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-1003
Mailing Address - Country:US
Mailing Address - Phone:423-775-5511
Mailing Address - Fax:423-775-5204
Practice Address - Street 1:6985 RHEA COUNTY HWY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-6208
Practice Address - Country:US
Practice Address - Phone:423-775-5511
Practice Address - Fax:423-775-5204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TN48183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4443812OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TNQ033471Medicaid