Provider Demographics
NPI:1891753745
Name:HOSPITAL DISCOUNT PHARMACY
Entity Type:Organization
Organization Name:HOSPITAL DISCOUNT PHARMACY
Other - Org Name:HOSPITAL DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-735-1234
Mailing Address - Street 1:124 LEBANON HWY
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-2955
Mailing Address - Country:US
Mailing Address - Phone:615-735-1234
Mailing Address - Fax:615-735-1234
Practice Address - Street 1:124 LEBANON HWY
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-2955
Practice Address - Country:US
Practice Address - Phone:615-735-1234
Practice Address - Fax:615-735-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2095077OtherPK
2095077OtherPK