Organization
MAIN STREET FAMILY PHARMACY LLC
Active
Organization
MAIN STREET FAMILY PHARMACY LLC
Active
Other names
MAIN STREET FAMILY PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTY NEWBAKER PHRMD (OWNER)
(731) 627-2221
Entity
Organization
Contact information
Practice address
126 E MAIN ST, NEWBERN, TN 38059-1527
(731) 627-2221
(731) 627-6152
Mailing address
126 E MAIN ST, NEWBERN, TN 38059-1527
(731) 627-2221
(731) 627-6152
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0895
TN
3336C0004X
Compounding Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1454920
—
TN
01
—
4441313
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/13/2008
Last updated
02/03/2010
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