Nuckolls Drug Stores, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

1253 Issued in TN

Legal business name

NUCKOLLS DRUG STORES, INC

Practice address

407 W Lafayette St
Bolivar, TN 38008-2651

Phone

(731) 658-2941

Fax

(731) 658-1758

NPI assigned

Jan 15, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Freeman Hunter Baird, BS

Title

President

Phone

(731) 658-2941

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Medical Arts Pharmacy Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202947200000",
    "number": "1013068220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 W LAFAYETTE ST",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380082651",
            "telephone_number": "731-658-2941",
            "fax_number": "731-658-1758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 W LAFAYETTE ST",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380082651",
            "telephone_number": "731-658-2941",
            "fax_number": "731-658-1758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUCKOLLS DRUG STORES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-15",
        "last_updated": "2008-02-14",
        "status": "A",
        "authorized_official_last_name": "BAIRD",
        "authorized_official_first_name": "FREEMAN",
        "authorized_official_middle_name": "HUNTER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "731-658-2941",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TN",
            "license": "1253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4401612",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Arts Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Danielle Mott
• Abubakar Mohammed Naida, MD
• New Primecare Clinics, Inc.
• Sylvestor D. Nicol, M.D.
• Felix Chukwudi Nnaji, MD
• Nuckolls Drug Stores, Inc
• James Kim Nuckolls, BS
• Keaton Overton
• Nithyananda Pakkala, M.D.
• Hope Caples Parker

• Community/Retail Pharmacy in Bolivar, TN
• Providers in Bolivar, TN by specialty
• Community/Retail Pharmacy in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.