Healthcare Provider Details

I. General information

NPI: 1972952976
Provider Name (Legal Business Name): DAR SALUD CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1068 CRESTHAVEN RD SUITE 300
MEMPHIS TN
38119-0800
US

IV. Provider business mailing address

1068 CRESTHAVEN RD SUITE 300
MEMPHIS TN
38119-0800
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-0024
  • Fax: 901-683-0028
Mailing address:
  • Phone: 901-922-5951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number00005805
License Number StateTN

VIII. Authorized Official

Name: GABRIEL VELASQUEZ
Title or Position: OPERATIONS DIRECTOR
Credential:
Phone: 901-922-5951