Provider Demographics
NPI:1629071956
Name:MEDEX BIOCARE PHARMACY, LLC.
Entity Type:Organization
Organization Name:MEDEX BIOCARE PHARMACY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ARATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-962-6339
Mailing Address - Street 1:8024 STAGE HILLS BLVD
Mailing Address - Street 2:STE 107
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4048
Mailing Address - Country:US
Mailing Address - Phone:800-962-6339
Mailing Address - Fax:866-755-6339
Practice Address - Street 1:8024 STAGE HILLS BLVD
Practice Address - Street 2:STE 107
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4048
Practice Address - Country:US
Practice Address - Phone:800-962-6339
Practice Address - Fax:866-755-6339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3956333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4437047OtherNCPDP NUMBER
TN3956OtherSTATE PHARMACY LICENSE