Cates Street Pharmacy LLC
Organization Active NPI Community/Retail Pharmacy · Dunlap, TN
NPI 1851364483 · NPPES record last updated Sep 2, 2025
Key facts
- NPI
- 1851364483
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 00003967 (TN)
- Legal business name
- CATES STREET PHARMACY LLC
- Practice address
- 104 Cates St
Dunlap, TN 37327-6093 - Phone
- (423) 949-5722
- Fax
- (423) 949-6176
- NPI assigned
- Feb 13, 2006
- Organization subpart
- No
Authorized official
- Name
- Jacob Standefer
- Title
- Manager
- Phone
- (423) 877-3568
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2211013 | Cates Street Pharmacy | Certificate of waiver | Jan 24, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Cates Street Pharmacy LLC |
Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Nebulizer Equipment and/or Supplies|Diabetic Shoes/Inserts - Custom | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930028979 | TN | DME Supplier - Pharmacy | 1658580311 | Practice locations: Dunlap, TN |
| O20160115000420 | TN | Part B Supplier - Mass Immunization (Roster Biller Only) | 1658580311 | Practice locations: Dunlap, TN |
National Provider Directory
Locations
104 Cates St
Dunlap, TN 37327
Phone (423) 949-5722
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 00003967 | TN | Yes |
Addresses
Primary practice location
104 Cates St
Dunlap, TN 37327-6093
Mailing address
PO Box 1685
Dunlap, TN 37327-1685
Phone (423) 949-5722
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2094085 | Other | PK | |
| Q047238 | Medicaid | TN |
Other names
- CATES STREET PHARMACY
Other providers in Dunlap, TN
- Caring Hearts of Dunlap
- Katelyn Roberta Carpenter
- Mitzi Serena Carrea
- Madilyn Cartwright
- Jenna Brooke Cate
- County of Sequatchie Office
- Covenant Medcare LLC
- Lisa Anne Cox
- Vanessa Curley
- John Eric Curtis
All providers in Dunlap, 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 Sep 2, 2025. 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.