Healthcare Provider Details

I. General information

NPI: 1942878392
Provider Name (Legal Business Name): ZACHARY MGBEMERE I PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 ELVIS PRESLEY BLVD
MEMPHIS TN
38116-8233
US

IV. Provider business mailing address

561 N JEFFERSON PL APT 3
MEMPHIS TN
38105-5253
US

V. Phone/Fax

Practice location:
  • Phone: 901-346-4994
  • Fax:
Mailing address:
  • Phone: 615-403-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-16635
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45106
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: