Healthcare Provider Details

I. General information

NPI: 1538839295
Provider Name (Legal Business Name): RYNE GOLDEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5169 BRUNSWICK RD
BRUNSWICK TN
38014
US

IV. Provider business mailing address

465 STATELINE RD W
SOUTHAVEN MS
38671-1611
US

V. Phone/Fax

Practice location:
  • Phone: 877-388-0507
  • Fax: 901-388-0407
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberE-100399
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number45621
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: