Provider Demographics
NPI:1508961368
Name:BELLS DEPOT, LLC
Entity Type:Organization
Organization Name:BELLS DEPOT, LLC
Other - Org Name:RAINES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:731-663-3331
Mailing Address - Street 1:PO BOX 1059
Mailing Address - Street 2:
Mailing Address - City:BELLS
Mailing Address - State:TN
Mailing Address - Zip Code:38006-1059
Mailing Address - Country:US
Mailing Address - Phone:731-663-3333
Mailing Address - Fax:731-663-0265
Practice Address - Street 1:13062 HIGHWAY 79
Practice Address - Street 2:
Practice Address - City:BELLS
Practice Address - State:TN
Practice Address - Zip Code:38006-3916
Practice Address - Country:US
Practice Address - Phone:731-663-3333
Practice Address - Fax:731-663-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
TN00000013763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ035573Medicaid
2088742OtherPK