Provider Demographics
NPI:1497538524
Name:THREE OAKS PHARMACY, LLC
Entity Type:Organization
Organization Name:THREE OAKS PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-618-1787
Mailing Address - Street 1:259 THREE OAKS DR STE A
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:TN
Mailing Address - Zip Code:38355-1501
Mailing Address - Country:US
Mailing Address - Phone:731-783-3300
Mailing Address - Fax:731-783-3900
Practice Address - Street 1:259 THREE OAKS DR STE A
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:TN
Practice Address - Zip Code:38355-1501
Practice Address - Country:US
Practice Address - Phone:731-783-3300
Practice Address - Fax:731-783-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy