MEDICARE: MEDEX BIOCARE PHARMACY, 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	333600000X	Pharmacy	3956	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4437047	OTHER		NCPDP NUMBER
2	3956	OTHER	TN	STATE PHARMACY LICENSE

General Provider Information

NPI Number	:	1629071956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDEX BIOCARE PHARMACY, LLC.

Provider Business Mailing Address
First Line	:	8024 STAGE HILLS BLVD
Second Line	:	STE 107
City	:	BARTLETT
State	:	TN
Zip	:	38133-4048
Country	:	US
Telephone Number	:	800-962-6339
Fax Number	:	866-755-6339

Provider Business Practice Location Address
First Line	:	8024 STAGE HILLS BLVD
Second Line	:	STE 107
City	:	BARTLETT
State	:	TN
Zip	:	38133-4048
Country	:	US
Telephone Number	:	800-962-6339
Fax Number	:	866-755-6339

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WILLIAM SCOTT ARATA
Credential	:
Telephone Number	:	800-962-6339

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	08/22/2020

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