Healthcare Provider Details

I. General information

NPI: 1760838528
Provider Name (Legal Business Name): MED RX PHARMACY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 UNION UNIVERSITY DR STE G
JACKSON TN
38305
US

IV. Provider business mailing address

1356 UNION UNIVERSITY DR STE G
JACKSON TN
38305
US

V. Phone/Fax

Practice location:
  • Phone: 731-300-7311
  • Fax: 731-300-7319
Mailing address:
  • Phone: 731-300-7311
  • Fax: 731-300-7319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5793
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRAD MEDLING
Title or Position: CEO
Credential:
Phone: 731-693-7351