Provider Demographics
NPI:1568775260
Name:TRI-MED PHARMACY LLC
Entity Type:Organization
Organization Name:TRI-MED PHARMACY LLC
Other - Org Name:ORION RX - HENDERSONVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY BILLING
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KONAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-269-9246
Mailing Address - Street 1:12468 LA GRANGE RD
Mailing Address - Street 2:#123
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-1901
Mailing Address - Country:US
Mailing Address - Phone:727-269-9246
Mailing Address - Fax:855-549-0648
Practice Address - Street 1:260 W MAIN ST STE 217
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-7312
Practice Address - Country:US
Practice Address - Phone:615-826-9393
Practice Address - Fax:855-549-0648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30893336L0003X
MS11500/7.13336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2126372OtherPK