Provider Demographics
NPI:1730294778
Name:GREG EDGIN
Entity Type:Organization
Organization Name:GREG EDGIN
Other - Org Name:SCOTTS HILL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:731-549-3927
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:640 HWY 114 SOUTH
Mailing Address - City:SCOTTS HILL
Mailing Address - State:TN
Mailing Address - Zip Code:38374-0247
Mailing Address - Country:US
Mailing Address - Phone:731-549-3927
Mailing Address - Fax:731-549-2323
Practice Address - Street 1:640 HIGHWAY 114 S
Practice Address - Street 2:
Practice Address - City:SCOTTS HILL
Practice Address - State:TN
Practice Address - Zip Code:38374-5023
Practice Address - Country:US
Practice Address - Phone:731-549-3927
Practice Address - Fax:731-549-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN20863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3560949Medicaid
4426157OtherNCPDP PROVIDER IDENTIFICATION NUMBER