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NPI Code Detail

MEDICARE: TRI-MED PHARMACY LLC

MEDICARE: TRI-MED PHARMACY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336L0003XLong Term Care Pharmacy4372TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12126379OTHERPK

General Provider Information

NPI Number : 1225342108
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRI-MED PHARMACY LLC
Provider Business Mailing Address
First Line : 12468 LA GRANGE RD
Second Line : #123
City : LOUISVILLE
State : KY
Zip : 40245-1901
Country : US
Telephone Number : 727-269-9246
Fax Number : 855-549-0648
Provider Business Practice Location Address
First Line : 2565 HORIZON LAKE DR STE 113
Second Line :
City : MEMPHIS
State : TN
Zip : 38133-8113
Country : US
Telephone Number : 901-969-0690
Fax Number : 855-549-0648
Authorized Official
Title or Position : DIRECTOR OF PHARMACY BILING
Name : AMY KONAK
Credential :
Telephone Number : 727-269-9246
Provider Enumeration Date : 08/03/2010
Last Update Date : 10/01/2015

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Directions to “TRI-MED PHARMACY LLC ” Practice Location

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