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NPI Code Detail

MEDICARE: MEDIPHARM INC

MEDICARE: MEDIPHARM INC
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
13336C0003XCommunity/Retail Pharmacy
2333600000XPharmacy
33336I0012XInstitutional Pharmacy
43336M0002XMail Order Pharmacy
53336S0011XSpecialty Pharmacy
63336L0003XLong Term Care Pharmacy4821TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14444080OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1780980631
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDIPHARM INC
Provider Business Mailing Address
First Line : 295 S BELLEVUE BLVD
Second Line : SUITE 1
City : MEMPHIS
State : TN
Zip : 38104-7517
Country : US
Telephone Number : 901-373-9955
Fax Number : 901-382-9966
Provider Business Practice Location Address
First Line : 295 S BELLEVUE BLVD STE 1A
Second Line :
City : MEMPHIS
State : TN
Zip : 38104-7517
Country : US
Telephone Number : 901-373-9955
Fax Number : 901-382-9966
Authorized Official
Title or Position : ADMINISTRATOR
Name : NYANDAY OTI
Credential :
Telephone Number : 901-373-9955
Provider Enumeration Date : 02/09/2011
Last Update Date : 03/16/2011

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Directions to “MEDIPHARM INC ” Practice Location

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