Standefer Pharmacy
Organization Active NPI Community/Retail Pharmacy · Pikeville, TN
NPI 1073671608 · NPPES record last updated May 20, 2016
Key facts
- NPI
- 1073671608
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 1069 (TN)
- Legal business name
- STANDEFER PHARMACY
- Practice address
- 3051 Main St
Pikeville, TN 37367-0150 - Phone
- (423) 447-2134
- Fax
- (423) 447-6330
- NPI assigned
- Dec 5, 2006
- Organization subpart
- No
Authorized official
- Name
- Fred Standefer
- Title
- Partner and Pharmacist
- Phone
- (423) 447-2134
Corporate family (same tax ID) 1
Practitioners 3
-
Leslie Rogers McWherter, PHARM D
-
Sarah Grace Standefer Olendorf, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2214559 | Standefer Pharmacy | Certificate of waiver | Feb 22, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Standefer Pharmacy |
Nebulizer Drugs | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081206000031 | TN | Part B Supplier - Mass Immunization (Roster Biller Only) | 7012078231 | Practice locations: Pikeville, TN |
| O20100930057368 | TN | DME Supplier - Pharmacy | 7012078231 | Practice locations: Pikeville, TN |
National Provider Directory
- Tax ID family
- Standefer Drug Center LLC
Locations
3051 Main St
Pikeville, TN 37367
Phone (423) 447-2134
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | 1069 | TN | Yes |
| Long Term Care Pharmacy | 3336L0003X | |||
| Mail Order Pharmacy | 3336M0002X |
Addresses
Primary practice location
3051 Main St
Pikeville, TN 37367-0150
Mailing address
PO Box 150
Pikeville, TN 37367-0150
Phone (423) 447-2134
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2095984 | Other | PK | |
| 3513097 | Medicaid | TN |
Other names
- STANDEFER DRUGCENTER
Other providers in Pikeville, TN
- Skills Training and Rehabilitation Services
- Michael Smith
- Tony Dwayne Smith
- Dorothy Spafford
- Standefer Drug Center LLC
- Fred Joel Standefer Jr.
- State of Tennesseee
- Diana Tapu Sanders
- Tennessee Em-I Medical Services, PC
- Tennessee River Physicians, PLLC
All providers in Pikeville, 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 May 20, 2016. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.