Organization
CUMBERLAND SPECIAL CARE PHARMACY LLC
Active
Other names
Cumberland Vital Care
Organization subpart
No
Provider details
NPI number
Authorized official
LANDON HEADRICK (OWNER/PIC)
(931) 456-0680
Entity
Organization
Contact information
Practice address
3106 MILLER AVE STE 101, CROSSVILLE, TN 38555-6118
(931) 456-0680
(931) 456-4857
Mailing address
PO BOX 2809, CROSSVILLE, TN 38557-2809
(931) 456-0680
(931) 456-4857
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
5708
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2157234
PK
—
05
—
Q020116
—
TN
Enumeration date
06/19/2015
Last updated
02/01/2021
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