Provider Demographics
NPI:1073625075
Name:PHARMCARE USA OF MEMPHIS, INC
Entity Type:Organization
Organization Name:PHARMCARE USA OF MEMPHIS, INC
Other - Org Name:PHARM CARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BARNEY
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-219-3619
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:HYDRO
Mailing Address - State:OK
Mailing Address - Zip Code:73048
Mailing Address - Country:US
Mailing Address - Phone:866-219-3619
Mailing Address - Fax:855-674-1913
Practice Address - Street 1:3449 COBBLESTONE BLVD. S
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-7075
Practice Address - Country:US
Practice Address - Phone:662-349-7151
Practice Address - Fax:855-674-1913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0003X, 3336I0012X, 3336L0003X
MS047603336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145455407Medicaid
TN3547793Medicaid
MS00030502OtherMEDICAID
2045940OtherPK
MS00030502Medicaid
MS00440753Medicaid
AR197606716Medicaid
TN357793Medicaid