Organization
NUCKOLLS DRUG STORES, INC
Active
Other names
Medical Arts Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
FREEMAN HUNTER BAIRD BS (PRESIDENT)
(731) 658-2941
Entity
Organization
Contact information
Practice address
407 W LAFAYETTE ST, BOLIVAR, TN 38008-2651
(731) 658-2941
(731) 658-1758
Mailing address
407 W LAFAYETTE ST, BOLIVAR, TN 38008-2651
(731) 658-2941
(731) 658-1758
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
1253
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4401612
—
TN
Enumeration date
01/15/2007
Last updated
02/14/2008
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