MEDICARE: ALLIANCE HEALTHCARE SERVICES BROAD PHARMACY

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	3336C0002X	Clinic Pharmacy

General Provider Information

NPI Number	:	1730983933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE HEALTHCARE SERVICES BROAD PHARMACY

Provider Business Mailing Address
First Line	:	2220 UNION AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-4315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 BROAD AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38112-3104
Country	:	US
Telephone Number	:	901-577-9400
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	SHAUNA SYKES
Credential	:
Telephone Number	:	901-577-9400

Provider Enumeration Date	:	04/04/2025
Last Update Date	:	04/07/2025

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