Organization
SOUTHMED LLC
Active
Other names
MEDICAP PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
LISA TIMBERLAKE RPH (OWNER PHARMACIST)
(901) 377-2225
Entity
Organization
Contact information
Practice address
2435 WHITTEN RD, SUITE 101, MEMPHIS, TN 38133-4715
(901) 377-2225
(901) 377-7992
Mailing address
2435 WHITTEN RD, SUITE 101, MEMPHIS, TN 38133-4715
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
4103
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4437958
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
4437958
—
TN
Enumeration date
11/15/2006
Last updated
03/07/2023
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