Provider Demographics
NPI:1962446278
Name:SMYRNA DRUG LP
Entity Type:Organization
Organization Name:SMYRNA DRUG LP
Other - Org Name:STONECREST REXALL DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-459-3411
Mailing Address - Street 1:300 STONECREST BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5689
Mailing Address - Country:US
Mailing Address - Phone:615-459-5117
Mailing Address - Fax:615-459-5106
Practice Address - Street 1:300 STONECREST BLVD STE 130
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5689
Practice Address - Country:US
Practice Address - Phone:615-459-5117
Practice Address - Fax:615-459-5106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3924333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4436831OtherOTHER ID NUMBER-COMMERCIAL NUMBER
TN4196120001Medicare NSC