Healthcare Provider Details

I. General information

NPI: 1083165104
Provider Name (Legal Business Name): ALLIANCE HEALTHCARE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 WINCHESTER RD
MEMPHIS TN
38118-6045
US

IV. Provider business mailing address

3810 WINCHESTER RD
MEMPHIS TN
38118-6045
US

V. Phone/Fax

Practice location:
  • Phone: 901-369-1421
  • Fax:
Mailing address:
  • Phone: 901-369-1421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number0000005868
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GENE LAWRENCE
Title or Position: CEO
Credential:
Phone: 901-369-1420