Provider Demographics
NPI:1518978162
Name:GARRETTS PHARMACY INC
Entity Type:Organization
Organization Name:GARRETTS PHARMACY INC
Other - Org Name:CLARKRANGE DRUG CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-864-3136
Mailing Address - Street 1:PO BOX 2007
Mailing Address - Street 2:
Mailing Address - City:CLARKRANGE
Mailing Address - State:TN
Mailing Address - Zip Code:38553-0307
Mailing Address - Country:US
Mailing Address - Phone:931-863-3779
Mailing Address - Fax:888-400-1390
Practice Address - Street 1:6404 S YORK HWY
Practice Address - Street 2:
Practice Address - City:CLARKRANGE
Practice Address - State:TN
Practice Address - Zip Code:38553-5138
Practice Address - Country:US
Practice Address - Phone:931-863-3779
Practice Address - Fax:888-400-1390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
TN20683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1452341Medicaid
2090975OtherPK
0272270002Medicare NSC