1972669240 NPI number — TRI MED PHARMACY SERVICES

Table of content: (NPI 1972669240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972669240 NPI number — TRI MED PHARMACY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI MED PHARMACY SERVICES
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:
1972669240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9830
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84109-9830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-540-4748
Provider Business Mailing Address Fax Number:
801-716-4872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
260 W MAIN ST
Provider Second Line Business Practice Location Address:
STE 217
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37075-3347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-826-9393
Provider Business Practice Location Address Fax Number:
615-824-0106
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING DIR
Authorized Official Telephone Number:
615-826-9393

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  3089 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4429999 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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