Provider Demographics
NPI:1518479831
Name:METHODIST HEALTHCARE-MEMPHIS HOSPITALS
Entity Type:Organization
Organization Name:METHODIST HEALTHCARE-MEMPHIS HOSPITALS
Other - Org Name:METHODIST GERMANTOWN OUTPATIENT PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SWIGGART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-516-6978
Mailing Address - Street 1:7705 POPLAR AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3969
Mailing Address - Country:US
Mailing Address - Phone:901-516-6506
Mailing Address - Fax:901-516-4104
Practice Address - Street 1:7705 POPLAR AVE STE 170
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3969
Practice Address - Country:US
Practice Address - Phone:901-516-6506
Practice Address - Fax:901-516-4104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336M0002X
TN62843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177523OtherPK