City Drug Store Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

0426 Issued in TN

Legal business name

CITY DRUG STORE INC

Doing business as

City Drug Store of Henderson TN Inc

Practice address

118 E Main St
Henderson, TN 38340-2335

Phone

(731) 989-2166

Fax

(731) 989-9685

NPI assigned

Jun 21, 2006

Last updated

Jul 8, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Deryl StewartNPI 1477609576

Title

President

Phone

(731) 989-2166

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• CITY DRUG STORE OF HENDERSON TN INC Doing business as

Medicare fee-for-service enrollment

Enrolled in TN2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Tax ID family

City Drug Institutional Care3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• City Drug Institutional Care

  • Long Term Care Pharmacy
  • Henderson, TN
  • NPI 1649475252
  NPD tax ID
• City Drug Store Inc

  dba City Drug Xpress

  • Community/Retail Pharmacy
  • Henderson, TN
  • NPI 1184713877
  NPD tax ID

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Deryl Lynn Stewart, PHARM.D.

  • Pharmacist
  • Henderson, TN
  • NPI 1477609576
  NPD (past) Authorized official
• Stacie Michelle Black, PHARM D

  • Pharmacist
  • Selmer, TN
  • NPI 1639225105
  NPD (past)
• Charles Daron McNatt, PHARM.D.

  • Pharmacist
  • Henderson, TN
  • NPI 1427104173
  NPD (past)
• Lynne Dana Moore, PHARM.D

  • Pharmacist
  • Henderson, TN
  • NPI 1467652305
  NPD (past)
• Jennifer Bias Morris, PHARM.D.

  • Pharmacist
  • Selmer, TN
  • NPI 1023131190
  NPD (past)

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467936000000",
    "number": "1285670083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 224",
            "city": "HENDERSON",
            "state": "TN",
            "postal_code": "383400224",
            "telephone_number": "731-989-2166",
            "fax_number": "731-989-9685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 E MAIN ST",
            "city": "HENDERSON",
            "state": "TN",
            "postal_code": "383402335",
            "telephone_number": "731-989-2166",
            "fax_number": "731-989-9685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY DRUG STORE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2016-07-08",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "DERYL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "731-989-2166"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TN",
            "license": "0426",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1452928",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2095494",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CITY DRUG STORE OF HENDERSON TN INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melissa Cherry
• Chester Co Healthcare, Inc. (Chester County Nursing Home)
• City Drug Institutional Care
• City Drug Medical Equipment, LLC
• City Drug Store Inc (City Drug Xpress)
• Stephanie M Coley, LCSW
• Shirley Ann Collier, APRN
• Stevie Cooksey
• Rhonda Shea Cooper, PT
• Patricia G Crane-Bryson, MD

• Community/Retail Pharmacy in Henderson, TN
• Providers in Henderson, 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 Jul 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.