=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710767058
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDTRONIC LOGISTICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2023
-----------------------------------------------------
Last Update Date | 10/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5300 AIRWAYS BLVD STE 101
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38116-9400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-344-0922
-----------------------------------------------------
Fax | 614-454-4200
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 243 LYNWOOD LN
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43130-8847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-381-6730
-----------------------------------------------------
Fax | 614-489-5164
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROJECT MANAGER
-----------------------------------------------------
Name | MS. KAY ELLEN KNOX
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-381-6730
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336M0002X
-----------------------------------------------------
Taxonomy Name | Mail Order Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------