MEDICARE: ANOVORX GROUP LLC

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	3336S0011X	Specialty Pharmacy	OSP.0006189	CO
2	3336S0011X	Specialty Pharmacy	PMP.833	HI
3	3336S0011X	Specialty Pharmacy	Y005790	AZ
4	3336S0011X	Specialty Pharmacy	A9-0001296	DE
5	3336S0011X	Specialty Pharmacy	64001473A	IN
6	3336S0011X	Specialty Pharmacy	054.018178	IL
7	3336S0011X	Specialty Pharmacy	34084MS	ID
8	3336S0011X	Specialty Pharmacy	PHNR000415	GA
9	3336S0011X	Specialty Pharmacy	4155	IA
10	3336S0011X	Specialty Pharmacy	NRP1461	CA
11	3336S0011X	Specialty Pharmacy	PH27151	FL
12	3336S0011X	Specialty Pharmacy	PCN.0002570	CT
13	3336S0011X	Specialty Pharmacy	NRX0000453	DC
14	3336S0011X	Specialty Pharmacy	22-13044	KS
15	3336S0011X	Specialty Pharmacy	1314	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
18	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
19	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
25	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
26	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
27	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
29	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
30	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31	2138743	OTHER	PK
32	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
33	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
34	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
35	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
36	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
37	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
38	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
39	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
40	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
41	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
42	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
43	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
44	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
45	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
46	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
47	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
48	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619213212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANOVORX GROUP LLC

Provider Business Mailing Address
First Line	:	1710 SHELBY OAKS DR N
Second Line	:	SUITE 2
City	:	MEMPHIS
State	:	TN
Zip	:	38134-7403
Country	:	US
Telephone Number	:	901-201-5470
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 SHELBY OAKS DR N
Second Line	:	SUITE 1
City	:	MEMPHIS
State	:	TN
Zip	:	38134-7403
Country	:	US
Telephone Number	:	901-201-5470
Fax Number	:	901-201-5465

Authorized Official
Title or Position	:	MANAGING MEMBER/PRESIDENT
Name	:	JON PETERS
Credential	:
Telephone Number	:	901-201-5484

Provider Enumeration Date	:	12/31/2012
Last Update Date	:	11/28/2018

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