Provider Demographics
NPI:1326913872
Name:TRICARE PHARMACY LLC
Entity type:Organization
Organization Name:TRICARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER & PIC
Authorized Official - Prefix:
Authorized Official - First Name:JEOBU
Authorized Official - Middle Name:
Authorized Official - Last Name:PETER
Authorized Official - Suffix:
Authorized Official - Credentials:MPHARM, DPH
Authorized Official - Phone:615-461-7078
Mailing Address - Street 1:710 NASHVILLE PIKE STE 101
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-4592
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:710 NASHVILLE PIKE STE 101
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-4592
Practice Address - Country:US
Practice Address - Phone:615-461-7078
Practice Address - Fax:615-461-8864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ036762Medicaid