Healthcare Provider Details

I. General information

NPI: 1700037595
Provider Name (Legal Business Name): FIRST PHARMACY SERVICES OF LINDEN AVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 N BELLEVUE BLVD
MEMPHIS TN
38104-2220
US

IV. Provider business mailing address

PO BOX 47
POPE MS
38658-0047
US

V. Phone/Fax

Practice location:
  • Phone: 901-946-1375
  • Fax: 901-725-0030
Mailing address:
  • Phone: 901-946-1375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number4573
License Number StateTN

VIII. Authorized Official

Name: DENISE PRATT
Title or Position: VICE PRESIDENT
Credential:
Phone: 901-355-2383