Organization
AMMED DIRECT LLC
Active
Other names
AMMED HOMECARE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY R THOMAS (SECRETARY)
(615) 905-5200
Entity
Organization
Contact information
Practice address
5720 CROSSINGS BLVD, STE B, ANTIOCH, TN 37013-3144
(615) 941-3800
(615) 941-3822
Mailing address
PO BOX 291569, NASHVILLE, TN 37229-1569
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
4128
TN
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145504
—
TN
01
—
4438001
OTHER ID NUMBER
—
Enumeration date
02/28/2006
Last updated
08/26/2015
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