Provider Demographics
NPI:1992032288
Name:PERSONAL PHARMACY CARE LLC
Entity Type:Organization
Organization Name:PERSONAL PHARMACY CARE LLC
Other - Org Name:PPC-RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CASEY
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:731-610-8273
Mailing Address - Street 1:11272 HIGHWAY 57
Mailing Address - Street 2:
Mailing Address - City:COUNCE
Mailing Address - State:TN
Mailing Address - Zip Code:38326-3802
Mailing Address - Country:US
Mailing Address - Phone:731-689-0223
Mailing Address - Fax:731-689-0253
Practice Address - Street 1:11272 HIGHWAY 57
Practice Address - Street 2:
Practice Address - City:COUNCE
Practice Address - State:TN
Practice Address - Zip Code:38326-3802
Practice Address - Country:US
Practice Address - Phone:731-689-0223
Practice Address - Fax:731-689-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-08
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08368/7.1333600000X
TN47063336L0003X
AL1133613336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL118443Medicaid
TN1992032288Medicaid
CO52757579Medicaid
MS04326518Medicaid
2122728OtherPK
MS04326518Medicaid