Healthcare Provider Details

I. General information

NPI: 1326983297
Provider Name (Legal Business Name): NEOVANCE SPECIALTY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 TUGGLE RD # 100
MEMPHIS TN
38118-7514
US

IV. Provider business mailing address

5025 TUGGLE RD # 100
MEMPHIS TN
38118-7514
US

V. Phone/Fax

Practice location:
  • Phone: 866-842-2147
  • Fax: 866-842-2147
Mailing address:
  • Phone: 866-842-2147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DONDRELL LESTER
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM.D.
Phone: 866-842-2147