BCP 1, LLC
Organization Active NPI Community/Retail Pharmacy · Dyersburg, TN
NPI 1013400167 · NPPES record last updated Jun 13, 2018
Key facts
- NPI
- 1013400167
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- BCP 1, LLC
- Practice address
- 2490 Parr Ave Ste 9
Dyersburg, TN 38024-2030 - Phone
- (731) 285-0844
- NPI assigned
- Jun 13, 2018
- Organization subpart
- Yes
- Parent organization (as reported)
- C & C PHARMACY, LLC
Authorized official
- Name
- Dr. Mark Brooks, PHARMD
- Title
- Pharmacist
- Phone
- (731) 285-0844
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190702002101 | TN | Part B Supplier - Pharmacy | 4385978980 | Practice locations: Dyersburg, TN |
National Provider Directory
- Part of
- C and C Pharmacy LLC
Locations
2490 Parr Ave
Ste 9
Dyersburg, TN 38024
Phone (731) 285-0844
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | TN | Yes |
Addresses
Primary practice location
2490 Parr Ave Ste 9
Dyersburg, TN 38024-2030
Mailing address
2490 Parr Ave Ste 9
Dyersburg, TN 38024-2030
Phone (731) 285-0844
Other names
- C & C Pharmacy
Other providers in Dyersburg, TN
- Melissa Lewis Barton
- Stephen Nye Barton
- Caro Fe Bassett
- Keno Bateman
- Deborah Baumgardner
- BCP 1, LLC
- BCP1, LLC Long Term Care
- Jeffrey Thomas Beasley
- Percy E Beasley
- Wanda Renee Beaver
All providers in Dyersburg, TN · Community/Retail Pharmacy in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.