Provider Demographics
NPI:1659381093
Name:COMMUNITY PHARMACY CARE INC
Entity Type:Organization
Organization Name:COMMUNITY PHARMACY CARE INC
Other - Org Name:DICKSON APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:615-446-5585
Mailing Address - Street 1:104 HIGHWAY 70 E
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2034
Mailing Address - Country:US
Mailing Address - Phone:615-446-5585
Mailing Address - Fax:615-446-7770
Practice Address - Street 1:104 HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2034
Practice Address - Country:US
Practice Address - Phone:615-446-5585
Practice Address - Fax:615-446-7770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
TN1123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2089343OtherPK
TN1452817Medicaid
6021370003Medicare NSC
3910015Medicare PIN