Provider Demographics
NPI: | 1891336285 |
---|---|
Name: | L & M INC. |
Entity Type: | Organization |
Organization Name: | L & M INC. |
Other - Org Name: | RIGGS DRUG |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PHARMACIST-IN-CHARGE/OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JONATHAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BROYLES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 423-494-1820 |
Mailing Address - Street 1: | 502 W CENTRAL AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | LA FOLLETTE |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37766-3400 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 423-562-5235 |
Mailing Address - Fax: | 423-566-2212 |
Practice Address - Street 1: | 502 W CENTRAL AVE |
Practice Address - Street 2: | |
Practice Address - City: | LA FOLLETTE |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37766-3400 |
Practice Address - Country: | US |
Practice Address - Phone: | 423-562-5235 |
Practice Address - Fax: | 423-566-2212 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-10-07 |
Last Update Date: | 2020-04-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | Q055608 | Medicaid |