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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