Provider Demographics
NPI:1558476598
Name:PREFERRED FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:PREFERRED FAMILY PHARMACY LLC
Other - Org Name:PREFERRED FAMILY PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:423-336-5522
Mailing Address - Street 1:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:TN
Mailing Address - Zip Code:37310-0455
Mailing Address - Country:US
Mailing Address - Phone:423-336-5522
Mailing Address - Fax:423-680-6101
Practice Address - Street 1:8896 HIWASSEE ST NW
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:TN
Practice Address - Zip Code:37310-5340
Practice Address - Country:US
Practice Address - Phone:423-336-5522
Practice Address - Fax:423-680-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
TN40913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454900Medicaid
2094609OtherPK
2094609OtherPK