Provider Demographics
NPI:1871606723
Name:STEWART PHARMACY, INC.
Entity type:Organization
Organization Name:STEWART PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NESTOR
Authorized Official - Middle Name:H
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:D PH
Authorized Official - Phone:931-473-5387
Mailing Address - Street 1:1100 SMITHVILLE HWY
Mailing Address - Street 2:SUITE 114
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1662
Mailing Address - Country:US
Mailing Address - Phone:931-473-5387
Mailing Address - Fax:931-506-8970
Practice Address - Street 1:1100 SMITHVILLE HWY
Practice Address - Street 2:SUITE 114
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1662
Practice Address - Country:US
Practice Address - Phone:931-473-5387
Practice Address - Fax:931-506-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000618332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3513602Medicaid
TN4091095OtherBLUE CROSS BLUE SHIELD
TN4091095OtherBLUE CROSS BLUE SHIELD