Organization
PHARMBLUE TENNESSEE LLC
Active
Other names
PharmBlue Tennessee LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL NELSON (OWNER, CEO, AO)
(724) 779-4720
Entity
Organization
Contact information
Practice address
1113 MURFREESBORO RD STE 319-B, FRANKLIN, TN 37064-1306
(615) 656-5417
(855) 331-4245
Mailing address
40 PENNWOOD PL, SUITE 300, WARRENDALE, PA 15086-6526
(724) 779-4720
(724) 779-4721
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0000005865
TN
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982056529
—
TN
01
—
2162030
PK
—
Enumeration date
07/07/2016
Last updated
03/31/2017
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