Provider Demographics
NPI:1427382688
Name:TRI-STATE RX LLC
Entity Type:Organization
Organization Name:TRI-STATE RX LLC
Other - Org Name:NATION'S MEDICINES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NATION
Authorized Official - Suffix:
Authorized Official - Credentials:RPH BS
Authorized Official - Phone:270-684-5398
Mailing Address - Street 1:3030 BURLEW BLVD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-6486
Mailing Address - Country:US
Mailing Address - Phone:270-684-5398
Mailing Address - Fax:270-683-8373
Practice Address - Street 1:3408 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-3302
Practice Address - Country:US
Practice Address - Phone:812-422-8255
Practice Address - Fax:270-685-5742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IN60006206A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122064OtherPK
M300018148OtherMEDICARE PTAN
4958220002Medicare NSC
IN200957790AMedicaid