1205259413 NPI number — FIRST PHARMACY SERVICES OF DIRECTORS ROW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205259413 NPI number — FIRST PHARMACY SERVICES OF DIRECTORS ROW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST PHARMACY SERVICES OF DIRECTORS ROW
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205259413
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 47
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POPE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38658-0047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-346-4306
Provider Business Mailing Address Fax Number:
901-346-4308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3171 DIRECTORS ROW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38131-0405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-346-4306
Provider Business Practice Location Address Fax Number:
901-346-4308
Provider Enumeration Date:
01/23/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PRATT
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
901-346-4306

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)