Provider Demographics
NPI:1457895344
Name:ENGIMA ENTERPRISES, INC
Entity Type:Organization
Organization Name:ENGIMA ENTERPRISES, INC
Other - Org Name:APOTHECARY CONVENIENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:M
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:615-645-9680
Mailing Address - Street 1:226 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-4021
Mailing Address - Country:US
Mailing Address - Phone:615-645-9680
Mailing Address - Fax:615-645-9782
Practice Address - Street 1:226 11TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-4021
Practice Address - Country:US
Practice Address - Phone:615-645-9680
Practice Address - Fax:615-645-9782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN354911835G0303X, 1835P2201X
TN17482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No1835G0303XPharmacy Service ProvidersPharmacistGeriatricGroup - Multi-Specialty
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory CareGroup - Multi-Specialty