Provider Demographics
NPI:1760783641
Name:CAVALIER PHARMACY LLC
Entity Type:Organization
Organization Name:CAVALIER PHARMACY LLC
Other - Org Name:CAVALIER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:731-692-3578
Mailing Address - Street 1:8 N CAVALIER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALAMO
Mailing Address - State:TN
Mailing Address - Zip Code:38001-6468
Mailing Address - Country:US
Mailing Address - Phone:731-696-4000
Mailing Address - Fax:731-696-4050
Practice Address - Street 1:8 N CAVALIER DR
Practice Address - Street 2:SUITE A
Practice Address - City:ALAMO
Practice Address - State:TN
Practice Address - Zip Code:38001-6468
Practice Address - Country:US
Practice Address - Phone:731-696-4000
Practice Address - Fax:731-696-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
TN48233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127327OtherPK