Healthcare Provider Details

I. General information

NPI: 1003643586
Provider Name (Legal Business Name): GADIEL CALEB ROSARIO NEGRON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 KIRBY RD
MEMPHIS TN
38119-8209
US

IV. Provider business mailing address

10428 EMMAS CIR N
COLLIERVILLE TN
38017-4101
US

V. Phone/Fax

Practice location:
  • Phone: 901-353-1387
  • Fax:
Mailing address:
  • Phone: 787-426-2646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number48262
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: