Organization
MEDIPHARM INC
Active
Other names
MediPharm Specialty Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
NYANDAY OTI (ADMINISTRATOR)
(901) 373-9955
Entity
Organization
Contact information
Practice address
295 S BELLEVUE BLVD STE 1A, MEMPHIS, TN 38104-7517
(901) 373-9955
(901) 382-9966
Mailing address
295 S BELLEVUE BLVD, SUITE 1, MEMPHIS, TN 38104-7517
(901) 373-9955
(901) 382-9966
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336I0012X
Institutional Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
4821
TN
3336M0002X
Mail Order Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4444080
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/09/2011
Last updated
03/16/2011
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