Provider Demographics
NPI:1992209001
Name:PRUITT'S DISCOUNT PHARMACY, LLC
Entity Type:Organization
Organization Name:PRUITT'S DISCOUNT PHARMACY, LLC
Other - Org Name:PRUITTS PHARMACY AT NEIGHBORHOOD HEALTH NAPIER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-562-6337
Mailing Address - Street 1:811 DICKERSON PIKE STE C
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-5633
Mailing Address - Country:US
Mailing Address - Phone:615-562-6337
Mailing Address - Fax:615-369-8759
Practice Address - Street 1:107 CHARLES E DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-2745
Practice Address - Country:US
Practice Address - Phone:615-415-7247
Practice Address - Fax:615-369-8759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
TN62673336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175559OtherPK