Provider Demographics
NPI:1629542493
Name:SHELBY COUNTY HEALTH CARE CORPORATION
Entity Type:Organization
Organization Name:SHELBY COUNTY HEALTH CARE CORPORATION
Other - Org Name:REGIONAL ONE HEALTH PHARMACY PCS WALNUT GROVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:WAGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-545-7676
Mailing Address - Street 1:877 JEFFERSON AVE
Mailing Address - Street 2:ATTENTION: PHARMACY ADMINISTRATION
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2807
Mailing Address - Country:US
Mailing Address - Phone:901-545-7847
Mailing Address - Fax:901-545-7552
Practice Address - Street 1:3109 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-3509
Practice Address - Country:US
Practice Address - Phone:901-515-3434
Practice Address - Fax:901-515-3439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4451578OtherNCPDP
TNQ047999Medicaid
FR8268143OtherDEA