Healthcare Provider Details

I. General information

NPI: 1538446646
Provider Name (Legal Business Name): BARDA SCALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 E SHELBY DR
MEMPHIS TN
38118-7256
US

IV. Provider business mailing address

3333 E SHELBY DR
MEMPHIS TN
38118-7256
US

V. Phone/Fax

Practice location:
  • Phone: 901-794-3690
  • Fax: 901-794-3689
Mailing address:
  • Phone: 901-794-3690
  • Fax: 901-794-3689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0000038600
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: