Provider Demographics
NPI:1508032251
Name:MCCORMICKS PHARMACY INC
Entity Type:Organization
Organization Name:MCCORMICKS PHARMACY INC
Other - Org Name:MCCORMICKS PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:615-672-7114
Mailing Address - Street 1:491 SAGE RD N
Mailing Address - Street 2:STE 1200
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-9360
Mailing Address - Country:US
Mailing Address - Phone:615-672-7114
Mailing Address - Fax:615-672-7164
Practice Address - Street 1:491 SAGE RD N
Practice Address - Street 2:STE 1200
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-9360
Practice Address - Country:US
Practice Address - Phone:615-672-7114
Practice Address - Fax:615-672-7164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000045023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2095363OtherPK
4441236OtherNCPDP PROVIDER IDENTIFICATION NUMBER