Provider Demographics
NPI:1932292117
Name:FAMILY MEDICAL CENTER PHARMACY INC
Entity Type:Organization
Organization Name:FAMILY MEDICAL CENTER PHARMACY INC
Other - Org Name:FAMILY MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUGHTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-597-4988
Mailing Address - Street 1:300 N CONGRESS BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-2704
Mailing Address - Country:US
Mailing Address - Phone:615-597-4988
Mailing Address - Fax:615-597-5321
Practice Address - Street 1:300 N CONGRESS BLVD
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-2704
Practice Address - Country:US
Practice Address - Phone:615-597-4988
Practice Address - Fax:615-597-5321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1125333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4400646OtherNCPDP PROVIDER IDENTIFICATION NUMBER