Provider Demographics
NPI:1518639806
Name:DECATUR PHARMACY, INC
Entity Type:Organization
Organization Name:DECATUR PHARMACY, INC
Other - Org Name:FIRST CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:423-565-0200
Mailing Address - Street 1:PO BOX 706
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TN
Mailing Address - Zip Code:37322-0706
Mailing Address - Country:US
Mailing Address - Phone:423-565-0200
Mailing Address - Fax:423-373-1500
Practice Address - Street 1:392 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TN
Practice Address - Zip Code:37322-7759
Practice Address - Country:US
Practice Address - Phone:423-486-9404
Practice Address - Fax:423-486-9434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-04
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy