Provider Demographics
NPI:1518404847
Name:SCOTLAND COUNTY COMMUNITY HEALTH DEVELOPMENT SERVICES, INC.
Entity Type:Organization
Organization Name:SCOTLAND COUNTY COMMUNITY HEALTH DEVELOPMENT SERVICES, INC.
Other - Org Name:MEMPHIS COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-465-8513
Mailing Address - Street 1:450 E SIGLER AVE STE A-2
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:MO
Mailing Address - Zip Code:63555-1726
Mailing Address - Country:US
Mailing Address - Phone:660-465-8513
Mailing Address - Fax:660-465-8569
Practice Address - Street 1:450 E SIGLER AVE
Practice Address - Street 2:SUITE A-2
Practice Address - City:MEMPHIS
Practice Address - State:MO
Practice Address - Zip Code:63555-1726
Practice Address - Country:US
Practice Address - Phone:512-596-2930
Practice Address - Fax:760-859-3614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO20170074733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2168202OtherPK