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General NPI Number Information
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NPI Number | 1225342108
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Entity Type | Organization
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Legal Business Name | TRI-MED PHARMACY LLC
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 10/01/2015
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Provider Practice Location Address
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Address Line | 2565 HORIZON LAKE DR STE 113
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City | MEMPHIS
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State | TN
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Zip | 38133-8113
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Country | US
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Telephone | 901-969-0690
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Fax | 855-549-0648
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Provider Business Mailing Address
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Address Line | 12468 LA GRANGE RD #123
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City | LOUISVILLE
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State | KY
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Zip | 40245-1901
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Country | US
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Telephone | 727-269-9246
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Fax | 855-549-0648
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY BILING
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Name | AMY KONAK
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Credential |
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Telephone | 727-269-9246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 4372
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License Number State | TN
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