Provider Demographics
NPI:1528415791
Name:BIG BEND PHARMACY, LLC
Entity Type:Organization
Organization Name:BIG BEND PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC/PHARMACY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:TAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-646-2279
Mailing Address - Street 1:5724 STAGE RD STE B
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-4572
Mailing Address - Country:US
Mailing Address - Phone:901-646-7701
Mailing Address - Fax:888-881-5570
Practice Address - Street 1:5724 STAGE RD STE B
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-4572
Practice Address - Country:US
Practice Address - Phone:901-646-7701
Practice Address - Fax:888-881-5570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy