Healthcare Provider Details

I. General information

NPI: 1316311418
Provider Name (Legal Business Name): INCEPTION RX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 FRANKLIN ROAD SUITE 200
BRENTWOOD TN
37027-4637
US

IV. Provider business mailing address

PO BOX 1007
BRENTWOOD TN
37024-1007
US

V. Phone/Fax

Practice location:
  • Phone: 629-203-6022
  • Fax: 615-376-4707
Mailing address:
  • Phone: 629-203-6022
  • Fax: 615-376-4707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5701
License Number StateTN

VIII. Authorized Official

Name: KEVIN R. HARTMAN
Title or Position: OWNER
Credential: PHARMD
Phone: 615-371-1210