Healthcare Provider Details

I. General information

NPI: 1073625075
Provider Name (Legal Business Name): PHARMCARE USA OF MEMPHIS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3449 COBBLESTONE BLVD. S
SOUTHAVEN MS
38672-7075
US

IV. Provider business mailing address

PO BOX 10
HYDRO OK
73048
US

V. Phone/Fax

Practice location:
  • Phone: 662-349-7151
  • Fax: 855-674-1913
Mailing address:
  • Phone: 866-219-3619
  • Fax: 855-674-1913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number04760
License Number StateMS

VIII. Authorized Official

Name: MR. BARNEY KENT ABBOTT
Title or Position: PRESIDENT/CEO
Credential:
Phone: 866-219-3619