Provider Demographics
NPI:1851408710
Name:NEWBERN DISCOUNT DRUG LLC
Entity Type:Organization
Organization Name:NEWBERN DISCOUNT DRUG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:731-627-9573
Mailing Address - Street 1:625 W MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:NEWBERN
Mailing Address - State:TN
Mailing Address - Zip Code:38059-1573
Mailing Address - Country:US
Mailing Address - Phone:731-627-9573
Mailing Address - Fax:731-627-3051
Practice Address - Street 1:625 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:NEWBERN
Practice Address - State:TN
Practice Address - Zip Code:38059-1573
Practice Address - Country:US
Practice Address - Phone:731-627-9573
Practice Address - Fax:731-627-3051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4418390OtherNCPDP
TN1454269Medicaid
5765780001Medicare NSC