Provider Demographics
NPI:1932261658
Name:DANNY B DEDMON
Entity Type:Organization
Organization Name:DANNY B DEDMON
Other - Org Name:CITY DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:B
Authorized Official - Last Name:DEDMON
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:731-285-7284
Mailing Address - Street 1:101 S MILL AVE
Mailing Address - Street 2:P O DRAWER C
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-4636
Mailing Address - Country:US
Mailing Address - Phone:731-285-7284
Mailing Address - Fax:731-285-8959
Practice Address - Street 1:101 S MILL AVE
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-4636
Practice Address - Country:US
Practice Address - Phone:731-285-7284
Practice Address - Fax:731-285-8959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1452252Medicaid
TN4406129OtherNABP -NCPDP
TN0339OtherPHARMACY LICENSE
TN0339OtherPHARMACY LICENSE
TN1161470001Medicare NSC