Healthcare Provider Details

I. General information

NPI: 1174077408
Provider Name (Legal Business Name): MEDIPHARM DISCOUNT PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 N GERMANTOWN PKWY
CORDOVA TN
38018-5892
US

IV. Provider business mailing address

1026 N GERMANTOWN PKWY
CORDOVA TN
38018-5892
US

V. Phone/Fax

Practice location:
  • Phone: 901-373-9955
  • Fax: 901-382-9966
Mailing address:
  • Phone: 901-373-9955
  • Fax: 901-382-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number4492
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROURKE SMITH
Title or Position: PRESIDENT
Credential:
Phone: 312-810-2200