Provider Demographics
NPI:1881765402
Name:P AND P PRESCRIPTION SHOP INC
Entity type:Organization
Organization Name:P AND P PRESCRIPTION SHOP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-824-1216
Mailing Address - Street 1:107 IMPERIAL BLVD
Mailing Address - Street 2:STE 9
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3479
Mailing Address - Country:US
Mailing Address - Phone:615-824-1216
Mailing Address - Fax:615-264-3784
Practice Address - Street 1:107 IMPERIAL BLVD
Practice Address - Street 2:STE 9
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3479
Practice Address - Country:US
Practice Address - Phone:615-824-1216
Practice Address - Fax:615-264-3784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
TN13373336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4401131OtherNCPDP PROVIDER IDENTIFICATION NUMBER