Provider Demographics
NPI:1821645201
Name:SC PHARMACY LLC
Entity Type:Organization
Organization Name:SC PHARMACY LLC
Other - Org Name:SPRING CITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:423-365-6351
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37381-0515
Mailing Address - Country:US
Mailing Address - Phone:423-365-6351
Mailing Address - Fax:423-365-4877
Practice Address - Street 1:171 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:SPRING CITY
Practice Address - State:TN
Practice Address - Zip Code:37381-4037
Practice Address - Country:US
Practice Address - Phone:423-365-6351
Practice Address - Fax:423-365-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ051561Medicaid