Organization Name: | TRICARE PHARMACY LLC |
NPI Number: | 1003166943 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JEOBU PETER (PHCY MGR,PIC,AO) |
Mailing Address: | 179 Hancock St Ste 301 Gallatin |
State: | TN US |
Postal Code: | 370666347 |
Phone Number: | 6154617078 |
Fax Number: | 6154618864 |
NPI Enumeration Date: | 09/18/2012 |
NPI Last Update Date: | 09/22/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 3336C0004X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Pharmacy |
Taxonomy Specialization: | Compounding Pharmacy |
Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |