Healthcare Provider Details

I. General information

NPI: 1073081972
Provider Name (Legal Business Name): TWELVESTONE MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 W NORTHFIELD BLVD STE 3A
MURFREESBORO TN
37129-1539
US

IV. Provider business mailing address

352 W NORTHFIELD BLVD STE 3A
MURFREESBORO TN
37129-1539
US

V. Phone/Fax

Practice location:
  • Phone: 844-893-0012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT KURTZ
Title or Position: MANAGER OF CONTRACTING
Credential:
Phone: 615-278-3385