Organization
CITY DRUG INSTITUTIONAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DERYL STEWART PHRMD (PRESIDENT)
(731) 989-2166
Entity
Organization
Contact information
Practice address
118 E MAIN ST, STE C, HENDERSON, TN 38340-2335
(731) 989-2166
(731) 989-9685
Mailing address
PO BOX 224, HENDERSON, TN 38340-0224
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
TN4396
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4440513
OTHER ID NUMBER
—
Enumeration date
06/15/2007
Last updated
09/13/2007
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