Provider Demographics
NPI:1134306012
Name:TRI-MED PHARMACY SERVICES, LLC #3
Entity Type:Organization
Organization Name:TRI-MED PHARMACY SERVICES, LLC #3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RPH
Authorized Official - Phone:423-664-1217
Mailing Address - Street 1:2195 VARNELL RD SW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-7347
Mailing Address - Country:US
Mailing Address - Phone:423-664-1217
Mailing Address - Fax:
Practice Address - Street 1:2195 VARNELL RD SW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-7347
Practice Address - Country:US
Practice Address - Phone:423-664-1217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI-MED PHARMACY SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4465314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4465OtherBOARD OF PHARMACY