Organization
STONEBRIDGE APOTHECARY LLC
Active
Other names
STONEBRIDGE APOTHECARY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID HUETER RPH (OWNER)
(721) 608-1186
Entity
Organization
Contact information
Practice address
111 STONEBRIDGE BLVD, STE A, JACKSON, TN 38305-2040
(731) 410-6787
(731) 410-6789
Mailing address
111 STONEBRIDGE BLVD, STE A, JACKSON, TN 38305-2040
(731) 410-6787
(731) 410-6789
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
4535
TN
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4441464
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/17/2008
Last updated
08/11/2010
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