Provider Demographics
NPI:1710979976
Name:CITY DRUG STORE OF PARSONS, INC
Entity Type:Organization
Organization Name:CITY DRUG STORE OF PARSONS, INC
Other - Org Name:CITY DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:731-847-6337
Mailing Address - Street 1:18 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:TN
Mailing Address - Zip Code:38363-2012
Mailing Address - Country:US
Mailing Address - Phone:731-847-6337
Mailing Address - Fax:731-847-6178
Practice Address - Street 1:18 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:TN
Practice Address - Zip Code:38363-2012
Practice Address - Country:US
Practice Address - Phone:731-847-6337
Practice Address - Fax:731-847-6178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1065333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3541405Medicaid
TN3541405Medicaid