Provider Demographics
NPI:1881833184
Name:WHITE BLUFF PRESCRIPTION LLC
Entity Type:Organization
Organization Name:WHITE BLUFF PRESCRIPTION LLC
Other - Org Name:WHITE BLUFF PRESCRIPTION LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-797-5899
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:WHITE BLUFF
Mailing Address - State:TN
Mailing Address - Zip Code:37187-0637
Mailing Address - Country:US
Mailing Address - Phone:615-797-5899
Mailing Address - Fax:615-797-5898
Practice Address - Street 1:4516 HWY 70 E
Practice Address - Street 2:
Practice Address - City:WHITE BLUFF
Practice Address - State:TN
Practice Address - Zip Code:37187-9220
Practice Address - Country:US
Practice Address - Phone:615-797-5899
Practice Address - Fax:615-797-5898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000046203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4442137OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TN6444340001Medicare NSC