Provider Demographics
NPI:1629177555
Name:COMMUNITY PHARMACY CARE INC
Entity Type:Organization
Organization Name:COMMUNITY PHARMACY CARE INC
Other - Org Name:KINGSTON SPRINGS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:615-446-5585
Mailing Address - Street 1:111 W KINGSTON SPRINGS RD
Mailing Address - Street 2:STE 103
Mailing Address - City:KINGSTON SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37082-9121
Mailing Address - Country:US
Mailing Address - Phone:615-952-3690
Mailing Address - Fax:615-952-3692
Practice Address - Street 1:111 W KINGSTON SPRINGS RD
Practice Address - Street 2:STE 103
Practice Address - City:KINGSTON SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37082-9121
Practice Address - Country:US
Practice Address - Phone:615-952-3690
Practice Address - Fax:615-952-3692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN43143336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2095132OtherPK
2095132OtherPK