Healthcare Provider Details

I. General information

NPI: 1316040447
Provider Name (Legal Business Name): MEMPHIS HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E H CRUMP BLVD
MEMPHIS TN
38126
US

IV. Provider business mailing address

360 E H CRUMP BLVD
MEMPHIS TN
38126
US

V. Phone/Fax

Practice location:
  • Phone: 901-261-2046
  • Fax: 901-946-9262
Mailing address:
  • Phone: 901-261-2046
  • Fax: 901-946-9262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number306
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. ISIAH MCRAY
Title or Position: PHARMACY DIRECTOR
Credential: PHARMD
Phone: 901-261-2081