Provider Demographics
NPI:1508836701
Name:REEVES DRUG STORE INC.
Entity Type:Organization
Organization Name:REEVES DRUG STORE INC.
Other - Org Name:REEVES HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:256-566-7980
Mailing Address - Street 1:125 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-3214
Mailing Address - Country:US
Mailing Address - Phone:931-363-0137
Mailing Address - Fax:931-424-8687
Practice Address - Street 1:125 N 1ST ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-3214
Practice Address - Country:US
Practice Address - Phone:931-363-0137
Practice Address - Fax:931-424-8687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000741332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3545832Medicaid
TN0149990001Medicare NSC