Provider Demographics
NPI:1548453053
Name:TRI-MED PHARMACY SERVICES, LLC #2
Entity type:Organization
Organization Name:TRI-MED PHARMACY SERVICES, LLC #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:615-826-9393
Mailing Address - Street 1:4005 S MENDENHALL RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-5919
Mailing Address - Country:US
Mailing Address - Phone:901-366-1988
Mailing Address - Fax:901-366-1679
Practice Address - Street 1:260 W MAIN ST
Practice Address - Street 2:SUITE 217
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3347
Practice Address - Country:US
Practice Address - Phone:615-826-9393
Practice Address - Fax:615-826-0531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000043723336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4440272OtherNCPDP