Organization
LEWISBURG COMPOUNDING CENTER
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
DENA FERMAN (THIRD PARTY PLAN COORDINATOR)
(314) 993-6000
Entity
Organization
Contact information
Practice address
733 W COMMERCE ST, LEWISBURG, TN 37091-3231
(931) 359-1383
(931) 359-1386
Mailing address
733 W COMMERCE ST, LEWISBURG, TN 37091-3231
(931) 359-1383
(931) 359-1386
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
1752
TN
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1455014
—
TN
01
—
4423098
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
02/02/2007
Last updated
03/07/2023
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