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General NPI Number Information
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NPI Number | 1396631404
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Entity Type | Organization
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Legal Business Name | TRI STATE COMMUNITY HEALTH CENTER
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 4041 KNIGHT ARNOLD RD STE 200
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City | MEMPHIS
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State | TN
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Zip | 38118-2128
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Country | US
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Telephone | 901-572-1573
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Fax | 901-261-7120
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Provider Business Mailing Address
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Address Line | 4041 KNIGHT ARNOLD RD STE 200
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City | MEMPHIS
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State | TN
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Zip | 38118-2128
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Country | US
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Telephone | 901-572-1573
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Fax | 901-261-7120
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | DR. TAMIKA D RUSSELL
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Credential | PHARM. D.
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Telephone | 901-572-1573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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