Provider Demographics
NPI:1487854634
Name:CUMBERLAND MEDICAL CENTER PHARMACY
Entity Type:Organization
Organization Name:CUMBERLAND MEDICAL CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLOG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-459-7122
Mailing Address - Street 1:421 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-5048
Mailing Address - Country:US
Mailing Address - Phone:931-459-7122
Mailing Address - Fax:931-456-6923
Practice Address - Street 1:421 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-5048
Practice Address - Country:US
Practice Address - Phone:931-459-7122
Practice Address - Fax:931-456-6923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000002313336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy