Basic Information
| Provider Information | |||||||||
| NPI: | 1568483527 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DANNYS DRUGS INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | DANNYS DRUGS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4129 | ||||||||
| Address2: | |||||||||
| City: | ONEIDA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378414129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235698652 | ||||||||
| FaxNumber: | 4235694080 | ||||||||
| Practice Location | |||||||||
| Address1: | 20029 ALBERTA ST | ||||||||
| Address2: | |||||||||
| City: | ONEIDA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378413501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235698652 | ||||||||
| FaxNumber: | 4235694080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 02/23/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SEXTON | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER / PIC | ||||||||
| AuthorizedOfficialTelephone: | 4235698652 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | N | Suppliers | Pharmacy | 3336C0003X | 1218 | TN | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 1452816 | 05 | TN | MEDICAID | 2094813 | 01 | PK | OTHER |