Healthcare Provider Details

I. General information

NPI: 1942453220
Provider Name (Legal Business Name): RESTORE RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5169 BRUNSWICK RD #305
BRUNSWICK TN
38014
US

IV. Provider business mailing address

PO BOX 305
BRUNSWICK TN
38014-0305
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number4578
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NATALIE MICHELLE RYAN
Title or Position: GENERAL MANAGER
Credential: PHARMD
Phone: 855-265-8008