Provider Demographics
NPI:1821054289
Name:DUREN CLINICAL SERVICES, LLC
Entity Type:Organization
Organization Name:DUREN CLINICAL SERVICES, LLC
Other - Org Name:DUREN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUREN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:931-722-5466
Mailing Address - Street 1:215 DEXTER L WOODS MEMORIAL BLVD
Mailing Address - Street 2:P. O. BOX 736
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485-2416
Mailing Address - Country:US
Mailing Address - Phone:931-722-5466
Mailing Address - Fax:931-722-9495
Practice Address - Street 1:215 DEXTER L WOODS MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-2416
Practice Address - Country:US
Practice Address - Phone:931-722-5466
Practice Address - Fax:931-722-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1452222Medicaid
TN4078454OtherTENNCARE SELECT
TN4078454OtherTENNCARE SELECT
TN1142510001Medicare NSC
TN3913837Medicare PIN