Healthcare Provider Details

I. General information

NPI: 1215903182
Provider Name (Legal Business Name): AMMED DIRECT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5720 CROSSINGS BLVD STE B
ANTIOCH TN
37013-3144
US

IV. Provider business mailing address

PO BOX 291569
NASHVILLE TN
37229-1569
US

V. Phone/Fax

Practice location:
  • Phone: 615-941-3800
  • Fax: 615-941-3822
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number4128
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KELLY R THOMAS
Title or Position: SECRETARY
Credential:
Phone: 615-905-5200