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General NPI Number Information
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NPI Number | 1942453220
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Entity Type | Organization
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Legal Business Name | RESTORE RX INC
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Dates
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Enumeration Date | 10/30/2008
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 5169 BRUNSWICK RD #305
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City | BRUNSWICK
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State | TN
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Zip | 38014
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Country | US
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Telephone | 901-388-0507
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Fax | 901-388-0407
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Provider Business Mailing Address
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Address Line | PO BOX 305
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City | BRUNSWICK
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State | TN
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Zip | 38014-0305
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Country | US
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Telephone | 901-388-0507
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Fax | 901-388-0407
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | NATALIE MICHELLE RYAN
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Credential | PHARMD
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Telephone | 855-265-8008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 4578
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License Number State | TN
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