Provider Demographics
NPI:1780756585
Name:DOCTORS HOSPITAL PHARMACY INC
Entity type:Organization
Organization Name:DOCTORS HOSPITAL PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-585-0470
Mailing Address - Street 1:420 W MORRIS BLVD
Mailing Address - Street 2:160A
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2283
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 W MORRIS BLVD
Practice Address - Street 2:160A
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2283
Practice Address - Country:US
Practice Address - Phone:423-585-0470
Practice Address - Fax:423-586-1431
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCTORS HOSPITAL PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-15
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3286333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1452927Medicaid
4431918OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0126540002Medicare ID - Type Unspecified