Provider Demographics
NPI:1518153972
Name:COMMUNITY PHARMACY CARE, INC
Entity Type:Organization
Organization Name:COMMUNITY PHARMACY CARE, INC
Other - Org Name:GOODLARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:615-446-8043
Mailing Address - Street 1:111 HWY 70 E
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2080
Mailing Address - Country:US
Mailing Address - Phone:615-446-8043
Mailing Address - Fax:
Practice Address - Street 1:111 HWY 70 E
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2080
Practice Address - Country:US
Practice Address - Phone:615-446-8043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN324332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6021370002Medicare NSC