Organization
TRI STATE RX, LLC
Active
Other names
Nation's Medicines
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK ALLEN HAYWOOD RPH (PHARMACY MANAGER)
(812) 962-4664
Entity
Organization
Contact information
Practice address
4849 POLLACK AVE, EVANSVILLE, IN 47715-5750
(812) 962-4664
(812) 962-4660
Mailing address
3030 BURLEW BLVD, OWENSBORO, KY 42303-6486
(270) 685-4931
(270) 685-5742
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
200460670A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200460670A
—
IN
Enumeration date
08/25/2008
Last updated
08/25/2008
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