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NPI Code Detail

MEDICARE: ANOVORX GROUP LLC

MEDICARE: ANOVORX GROUP 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
13336C0003XCommunity/Retail Pharmacy15077/7.1MS
2333600000XPharmacy2017009958MO
33336C0003XCommunity/Retail Pharmacy5905TN
43336C0003XCommunity/Retail PharmacyOS02761AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12166497OTHERPK

General Provider Information

NPI Number : 1992248702
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANOVORX GROUP LLC
Provider Business Mailing Address
First Line : 1710 SHELBY OAKS DR N
Second Line : SUITE 5
City : MEMPHIS
State : TN
Zip : 38134-7403
Country : US
Telephone Number : 901-201-5470
Fax Number : 901-201-5465
Provider Business Practice Location Address
First Line : 1710 SHELBY OAKS DR N STE 5
Second Line :
City : MEMPHIS
State : TN
Zip : 38134-7403
Country : US
Telephone Number : 901-201-5470
Fax Number : 901-201-5465
Authorized Official
Title or Position : PRESIDENT, MANAGING MEMBER AND DIRE
Name : JON PETERS
Credential :
Telephone Number : 901-201-5484
Provider Enumeration Date : 11/28/2016
Last Update Date : 04/24/2017

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Directions to “ANOVORX GROUP LLC ” Practice Location

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