Dyer Station Pharmacy, LLC
Organization Active NPI Community/Retail Pharmacy · Dyer, TN
NPI 1376526517 · NPPES record last updated Nov 13, 2021
Key facts
- NPI
- 1376526517
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 2878 (TN)
- Legal business name
- DYER STATION PHARMACY, LLC
- Practice address
- 137 S Main St
Dyer, TN 38330-1815 - Phone
- (731) 692-3578
- Fax
- (731) 692-4219
- NPI assigned
- Nov 22, 2005
- Organization subpart
- No
Authorized official
- Name
- Dr. Derek Holyfield, PHARM. D
- Title
- Managing Partner
- Phone
- (731) 692-3578
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930094311 | TN | DME Supplier - Pharmacy | 2264642123 | Practice locations: Dyer, TN |
| O20151001000291 | TN | Part B Supplier - Mass Immunization (Roster Biller Only) | 2264642123 | Practice locations: Dyer, TN |
National Provider Directory
- Tax ID family
- Duncan'S Pharmacy
Locations
137 S Main St
Dyer, TN 38330
Phone (731) 692-3578
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 2878 | TN | |
| Community/Retail Pharmacy | 3336C0003X | 2878 | TN | Yes |
| Compounding Pharmacy | 3336C0004X |
Addresses
Primary practice location
137 S Main St
Dyer, TN 38330-1815
Mailing address
PO Box 265
Dyer, TN 38330-0265
Phone (731) 692-3578
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1454681 | Medicaid | TN |
Other names
- Duncan's Pharmacy
Other providers in Dyer, TN
- Jamie Burrus
- Jenna Lee Dubruiel
- Douglas R Duncan
- Dyer Nursing Home, Inc.
- Dyer Station Pharmacy, LLC
- Dyer Station Pharmacy, LLC
- Karen R Emison
- Philip Greg Emison
- Karin Featherston
- Kalie Foust
All providers in Dyer, 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 Nov 13, 2021. 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.