NPIMap

Organization Active NPI

Sullivans Hometown Pharmacy LLC

  • Community/Retail Pharmacy
  • McMinnville, TN
National Provider Identifier
1598074411
Registry record updated Oct 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
4794 Issued in TN
Legal business name
SULLIVANS HOMETOWN PHARMACY LLC
Practice address
231 Northgate Dr Ste 100
McMinnville, TN 37110-1436
Phone
(931) 474-5050
Fax
(931) 474-5053
NPI assigned
Sep 27, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2010

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

Authorized official

Name
Donald Sullivan
Title
President
Phone
(931) 474-5050

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 4794 TN Primary

Addresses

Primary practice location

231 Northgate Dr Ste 100
McMinnville, TN 37110-1436

Mailing address

231 Northgate Dr
Suite 100
McMinnville, TN 37110-1426
Phone (931) 474-5050

Other identifiers 1

IdentifierTypeStateIssuer
4443583OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • SULLIVANS HOMETOWN PHARMACY LLC Doing business as

National Provider Directory

National Provider Directory

Locations

231 Northgate Dr
Ste 100
McMinnville, TN 37110
Phone (931) 474-5050

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1285545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287014400000",
    "number": "1598074411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 NORTHGATE DR",
            "address_2": "SUITE 100",
            "city": "MCMINNVILLE",
            "state": "TN",
            "postal_code": "371101426",
            "telephone_number": "931-474-5050",
            "fax_number": "931-474-5053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231 NORTHGATE DR STE 100",
            "city": "MCMINNVILLE",
            "state": "TN",
            "postal_code": "371101436",
            "telephone_number": "931-474-5050",
            "fax_number": "931-474-5053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVANS HOMETOWN PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-27",
        "last_updated": "2010-10-14",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "931-474-5050"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TN",
            "license": "4794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4443583",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SULLIVANS HOMETOWN PHARMACY LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in McMinnville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2010; 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.