Organization
MIDDLE TENNESSEE PHARMACY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSS SPIVEY D.P.H (PHARMACIST IN CHARGE)
(931) 684-9987
Entity
Organization
Contact information
Practice address
336 S CANNON BLVD, SHELBYVILLE, TN 37160-3914
(931) 684-9987
(931) 684-9995
Mailing address
336 S CANNON BLVD, SHELBYVILLE, TN 37160-3914
(931) 684-9987
(931) 684-9995
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
0000004147
TN
3336C0004X
Compounding Pharmacy
0000004147
TN
3336H0001X
Home Infusion Therapy Pharmacy
0000004147
TN
3336L0003X
Long Term Care Pharmacy
0000004147
TN
3336S0011X
Specialty Pharmacy
0000004147
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1455133
TENNCARE
TN
01
—
4135181
BCBS TN DME
TN
01
—
4138194
BCBS TN HIT
TN
05
—
4438140
—
TN
Enumeration date
06/19/2006
Last updated
06/18/2008
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