Healthcare Provider Details

I. General information

NPI: 1679120281
Provider Name (Legal Business Name): SHELBY COUNTY HEALTH CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 STAGE POST DR STE 102-104
BARTLETT TN
38133-4042
US

IV. Provider business mailing address

877 JEFFERSON AVE ATTENTION: PHARMACY ADMIN. 2ND FLOOR TURNER TOWER
MEMPHIS TN
38103-2807
US

V. Phone/Fax

Practice location:
  • Phone: 901-545-7847
  • Fax: 901-545-7557
Mailing address:
  • Phone: 901-545-7847
  • Fax: 901-545-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES RICHARD WAGERS JR.
Title or Position: SEVP AND CFO
Credential:
Phone: 901-545-7676