Provider Demographics
NPI:1265607329
Name:MCEWEN DRUG
Entity type:Organization
Organization Name:MCEWEN DRUG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:NEBLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-535-3721
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:MC EWEN
Mailing Address - State:TN
Mailing Address - Zip Code:37101-0115
Mailing Address - Country:US
Mailing Address - Phone:931-535-3721
Mailing Address - Fax:
Practice Address - Street 1:562 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:NEW JOHNSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37134-2130
Practice Address - Country:US
Practice Address - Phone:931-535-3721
Practice Address - Fax:931-535-3731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000044963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4441262OtherNCPDP PROVIDER IDENTIFICATION NUMBER