1174677058 NPI number — PHARMA CARE, INC.

Table of content: (NPI 1174677058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174677058 NPI number — PHARMA CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMA CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174677058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1051 S RIVERSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37040-4303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-906-9450
Provider Business Mailing Address Fax Number:
931-645-6800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2404 MEMORIAL BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37172-3921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-384-9155
Provider Business Practice Location Address Fax Number:
615-384-9411
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZAVER
Authorized Official First Name:
BHARAT
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER-PRESIDENT
Authorized Official Telephone Number:
931-645-2494

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  2286 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 759 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0186231 . This is a "TENNCARE SELECT" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1452381 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0186231 . This is a "BCBS NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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