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General NPI Number Information
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NPI Number | 1710959614
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Entity Type | Organization
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Legal Business Name | SHELBY COUNTY HEALTH CARE CORPORATION
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 04/24/2020
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Provider Practice Location Address
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Address Line | 877 JEFFERSON AVE
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City | MEMPHIS
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State | TN
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Zip | 38103-2807
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Country | US
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Telephone | 901-545-6299
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Fax | 901-545-7557
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Provider Business Mailing Address
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Address Line | 877 JEFFERSON AVE ATTENTION OUTPATIENT PHARMACY
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City | MEMPHIS
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State | TN
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Zip | 38103-2807
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Country | US
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Telephone | 901-545-6299
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Fax | 901-545-7557
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | MARY KAY RYAN
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Credential | DPH
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Telephone | 901-545-7847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 744
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License Number State | TN
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