Organization
CITY DRUG STORE INC
Active
Other names
CITY DRUG STORE OF HENDERSON TN INC
Organization subpart
No
Provider details
NPI number
Authorized official
DERYL STEWART (PRESIDENT)
(731) 989-2166
Entity
Organization
Contact information
Practice address
118 E MAIN ST, HENDERSON, TN 38340-2335
(731) 989-2166
(731) 989-9685
Mailing address
PO BOX 224, HENDERSON, TN 38340-0224
(731) 989-2166
(731) 989-9685
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0426
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1452928
—
TN
01
—
2095494
PK
—
Enumeration date
06/21/2006
Last updated
07/08/2016
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