Organization
MEDIPHARM INC.
Active
Other names
MediPharm Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
NYANDAY R. OTI (ADMINISTRATOR/CEO)
(901) 746-9631
Entity
Organization
Contact information
Practice address
295 S BELLEVUE BLVD, SUITE # 3, MEMPHIS, TN 38104-7517
(901) 746-9631
(901) 791-9292
Mailing address
295 S BELLEVUE BLVD, SUITE # 3, MEMPHIS, TN 38104-7517
(901) 746-9631
(901) 791-9292
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD7664
TN
246RP1900X
Phlebotomy Technician
44D2021574
TN
363LF0000X
Family Nurse Practitioner
APN 16134
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780980631
SPECIALTY PHARMACY
TN
01
—
1942476528
RETAIL PHARMACY
TN
Enumeration date
07/08/2011
Last updated
11/28/2011
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