Carol H Wallace
Organization Active NPI Community/Retail Pharmacy · Winchester, TN
NPI 1962581702 · NPPES record last updated Aug 14, 2025
Key facts
- NPI
- 1962581702
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 0000001203 (TN)
- Legal business name
- CAROL H WALLACE
- Practice address
- 1201 Dinah Shore Boulevard
Winchester, TN 37398 - Phone
- (931) 967-2777
- Fax
- (931) 967-1264
- NPI assigned
- Nov 3, 2006
- Organization subpart
- No
Authorized official
- Name
- Carol Wallace, PHARM.D
- Title
- Pic Owner
- Phone
- (931) 967-2777
Practitioners 8
-
Carol Henshaw Wallace, PHARMACIST
-
Jasmine Jara Arellano, PHARMD
-
Kyle Ashby, PHARM.D.T
-
Cynthia Kennedy McDonald, D.PH.
-
Ann C Richardson, DPH
-
Ginny Stluka, PHARM.D.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Carol H Wallace |
Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers|Ostomy Supplies|Urological Supplies|Lymphedema Compression Treatment Items | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140501001412 | TN | Part B Supplier - Mass Immunization (Roster Biller Only) | 1355574153 | Practice locations: Winchester, TN |
National Provider Directory
Locations
1201 Dinah Shore Blvd
Winchester, TN 37398
Phone (931) 967-2777
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 0000001203 | TN | Yes |
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
1201 Dinah Shore Boulevard
Winchester, TN 37398
Mailing address
PO Box 70
1201 Dinah Shore Boulevard
Winchester, TN 37398
Phone (931) 967-2777
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2094785 | Other | PK | |
| 1534061 | Medicaid | TN |
Other names
- BENNETT'S PHARMACY
Other providers in Winchester, TN
- Bryan Myers MD PC
- Michelle Katherine Bull
- Albert V Bystritski
- Charlene A Campbell
- Caresouth HHA Holdings of Winchester LLC
- Kimberly Cates
- Jolynne Chapman Chapman
- Charles D Ganime DPM
- Kou Wei Chiu
- Laurie Choate-Kelley
All providers in Winchester, 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 Aug 14, 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.