Provider Demographics
NPI:1457387649
Name:SCPG TENNESSEE LLC
Entity Type:Organization
Organization Name:SCPG TENNESSEE LLC
Other - Org Name:EXPRESS RX OF PLEASANT VIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GALEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-259-4399
Mailing Address - Street 1:PO BOX 34407, PMB 53760
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72203-4420
Mailing Address - Country:US
Mailing Address - Phone:870-761-0980
Mailing Address - Fax:615-746-3784
Practice Address - Street 1:6361 HIGHWAY 41A
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:TN
Practice Address - Zip Code:37146
Practice Address - Country:US
Practice Address - Phone:615-746-8432
Practice Address - Fax:615-746-3784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TN1093336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454762Medicaid
TN9441336Medicaid
2089594OtherPK
TN1454762Medicaid
TN1454762Medicaid