Provider Demographics
NPI:1760864748
Name:INFINITY LTC PHARMACY INC
Entity Type:Organization
Organization Name:INFINITY LTC PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-520-1001
Mailing Address - Street 1:1080 NEAL ST STE 104
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-0942
Mailing Address - Country:US
Mailing Address - Phone:931-520-1001
Mailing Address - Fax:931-520-1345
Practice Address - Street 1:1080 NEAL ST STE 104
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0942
Practice Address - Country:US
Practice Address - Phone:931-520-1001
Practice Address - Fax:931-520-1345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherTAX ID