Provider Demographics
NPI:1487657805
Name:CITY DRUG COMPANY, INC
Entity Type:Organization
Organization Name:CITY DRUG COMPANY, INC
Other - Org Name:CITY DRUG COMPANY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:270-444-7070
Mailing Address - Street 1:630 RB WILSON DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:TN
Mailing Address - Zip Code:38344-1726
Mailing Address - Country:US
Mailing Address - Phone:731-986-2228
Mailing Address - Fax:731-986-2171
Practice Address - Street 1:630 RB WILSON DR
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:TN
Practice Address - Zip Code:38344-1726
Practice Address - Country:US
Practice Address - Phone:731-986-2228
Practice Address - Fax:731-986-2171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN4433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131844OtherPK
TN3526215Medicaid
0558770001Medicare NSC
TN3526215Medicaid