Healthcare Provider Details

I. General information

NPI: 1447278221
Provider Name (Legal Business Name): AMPHARM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 TENNESSEE AVE N
PARSONS TN
38363
US

IV. Provider business mailing address

PO BOX 10
PARSONS TN
38363-0010
US

V. Phone/Fax

Practice location:
  • Phone: 731-847-4013
  • Fax: 855-508-8372
Mailing address:
  • Phone: 731-847-4013
  • Fax: 855-508-8372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number3447
License Number StateTN

VIII. Authorized Official

Name: ROBIN F BRADLEY
Title or Position: SECRETARY
Credential:
Phone: 615-595-8383