Provider Demographics
NPI:1144557828
Name:ALANA HEALTHCARE PHARMACY
Entity type:Organization
Organization Name:ALANA HEALTHCARE PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PHARMACY OPS
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:615-375-1094
Mailing Address - Street 1:PO BOX 1469
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37056-1469
Mailing Address - Country:US
Mailing Address - Phone:615-375-1094
Mailing Address - Fax:615-375-1132
Practice Address - Street 1:636 DIVISION ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-4654
Practice Address - Country:US
Practice Address - Phone:615-375-1094
Practice Address - Fax:877-471-2484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336M0002X, 3336C0003X, 333600000X
TN47013336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80535364Medicaid
ID1144557828Medicaid
4442808OtherNCPDP PROVIDER IDENTIFICATION NUMBER
IN200982350AMedicaid
CO80535364Medicaid