Provider Demographics
NPI:1023583747
Name:TIPTONVILLE FAMILY PHARMACY
Entity type:Organization
Organization Name:TIPTONVILLE FAMILY PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-499-1168
Mailing Address - Street 1:650 CARL PERKINS PKWY
Mailing Address - Street 2:
Mailing Address - City:TIPTONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38079-1678
Mailing Address - Country:US
Mailing Address - Phone:731-253-0153
Mailing Address - Fax:731-623-5025
Practice Address - Street 1:650 CARL PERKINS PKWY
Practice Address - Street 2:
Practice Address - City:TIPTONVILLE
Practice Address - State:TN
Practice Address - Zip Code:38079-1678
Practice Address - Country:US
Practice Address - Phone:731-253-0153
Practice Address - Fax:731-253-0143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy