Provider Demographics
NPI:1154050557
Name:MEDSOURCE
Entity Type:Organization
Organization Name:MEDSOURCE
Other - Org Name:MEDSOURCE SCRIPTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:EMPEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:931-896-2126
Mailing Address - Street 1:1849 MADISON ST, SUITE D
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043
Mailing Address - Country:US
Mailing Address - Phone:931-896-2126
Mailing Address - Fax:931-896-2127
Practice Address - Street 1:1849 MADISON ST, SUITE D
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:931-896-2126
Practice Address - Fax:931-896-2127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy