Healthcare Provider Details

I. General information

NPI: 1396631404
Provider Name (Legal Business Name): TRI STATE COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 08/29/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 KNIGHT ARNOLD RD STE 200
MEMPHIS TN
38118-2128
US

IV. Provider business mailing address

4041 KNIGHT ARNOLD RD STE 200
MEMPHIS TN
38118-2128
US

V. Phone/Fax

Practice location:
  • Phone: 901-572-1573
  • Fax: 901-261-7120
Mailing address:
  • Phone: 901-572-1573
  • Fax: 901-261-7120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. TAMIKA D RUSSELL
Title or Position: PHARMACY MANAGER
Credential: PHARM. D.
Phone: 901-572-1573