MEDICARE: MR. THOMAS RANDALL GUNTHARP RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	11508	TN
2	183500000X	Pharmacist	08642	MS
3	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	11508	TN

General Provider Information

NPI Number	:	1497055230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS RANDALL GUNTHARP RPH

Provider Business Mailing Address
First Line	:	1788 CHARRINGTON LN
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-7614
Country	:	US
Telephone Number	:	901-239-6117
Fax Number	:

Provider Business Practice Location Address
First Line	:	4770 RIVERDALE RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38141-8529
Country	:	US
Telephone Number	:	901-752-6263
Fax Number	:	901-758-3650

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2010
Last Update Date	:	02/14/2020

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