Organization
SULLIVANS HOMETOWN PHARMACY LLC
Active
Organization
SULLIVANS HOMETOWN PHARMACY LLC
Active
Other names
SULLIVANS HOMETOWN PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD SULLIVAN (PRESIDENT)
(931) 474-5050
Entity
Organization
Contact information
Practice address
231 NORTHGATE DR STE 100, MCMINNVILLE, TN 37110-1436
(931) 474-5050
(931) 474-5053
Mailing address
231 NORTHGATE DR, SUITE 100, MCMINNVILLE, TN 37110-1426
(931) 474-5050
(931) 474-5053
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
4794
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4443583
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/27/2010
Last updated
10/14/2010
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