Provider Demographics
NPI:1588636377
Name:MARCROMS PHARMACY, P C
Entity Type:Organization
Organization Name:MARCROMS PHARMACY, P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCROM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:931-728-1100
Mailing Address - Street 1:1277 MCARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-2423
Mailing Address - Country:US
Mailing Address - Phone:931-728-1100
Mailing Address - Fax:931-723-4137
Practice Address - Street 1:1277 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2423
Practice Address - Country:US
Practice Address - Phone:931-728-1100
Practice Address - Fax:931-723-4137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN243183500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3535840Medicaid
TN0248860001Medicare NSC
3912829Medicare PIN