Healthcare Provider Details

I. General information

NPI: 1568811099
Provider Name (Legal Business Name): RMSS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N OAK AVE
COOKEVILLE TN
38501-2440
US

IV. Provider business mailing address

330 N OAK AVE
COOKEVILLE TN
38501-2440
US

V. Phone/Fax

Practice location:
  • Phone: 931-559-6337
  • Fax: 931-559-1002
Mailing address:
  • Phone: 931-559-6337
  • Fax: 931-559-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5799
License Number StateTN

VIII. Authorized Official

Name: DR. JONATHAN CLINT MELTON
Title or Position: OWNER / OFFICER
Credential:
Phone: 931-403-2552