Basic Information
| Provider Information | |||||||||
| NPI: | 1871966499 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HCCHC PHARMACY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 629 NUCKOLLS RD | ||||||||
| Address2: | PO BOX 720 | ||||||||
| City: | BOLIVAR | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380081599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316583388 | ||||||||
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| Practice Location | |||||||||
| Address1: | 629 NUCKOLLS RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | BOLIVAR | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380081599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316583388 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2015 | ||||||||
| LastUpdateDate: | 11/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | LOVELACE | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7316593125 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0002X | Y | Suppliers | Pharmacy | Clinic Pharmacy |
No ID Information.