Healthcare Provider Details

I. General information

NPI: 1972669240
Provider Name (Legal Business Name): TRI MED PHARMACY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 W MAIN ST STE 217
HENDERSONVILLE TN
37075-3347
US

IV. Provider business mailing address

PO BOX 9830
SALT LAKE CITY UT
84109-9830
US

V. Phone/Fax

Practice location:
  • Phone: 615-826-9393
  • Fax: 615-824-0106
Mailing address:
  • Phone: 877-540-4748
  • Fax: 801-716-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number3089
License Number StateTN

VIII. Authorized Official

Name: EDWARD SMITH
Title or Position: MANAGING DIR
Credential: DPH
Phone: 615-826-9393