Provider Demographics
NPI:1902028533
Name:BLUE FRONT DRUG,INC
Entity Type:Organization
Organization Name:BLUE FRONT DRUG,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:HERD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:931-967-2251
Mailing Address - Street 1:107 1ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398
Mailing Address - Country:US
Mailing Address - Phone:931-967-2251
Mailing Address - Fax:931-967-6646
Practice Address - Street 1:107 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-1643
Practice Address - Country:US
Practice Address - Phone:931-967-2251
Practice Address - Fax:931-967-6646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1306920434Medicare UPIN