Provider Demographics
NPI:1710959614
Name:SHELBY COUNTY HEALTH CARE CORPORATION
Entity Type:Organization
Organization Name:SHELBY COUNTY HEALTH CARE CORPORATION
Other - Org Name:REGIONAL ONE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:901-545-7847
Mailing Address - Street 1:877 JEFFERSON AVE
Mailing Address - Street 2:ATTENTION OUTPATIENT PHARMACY
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2807
Mailing Address - Country:US
Mailing Address - Phone:901-545-6299
Mailing Address - Fax:901-545-7557
Practice Address - Street 1:877 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2807
Practice Address - Country:US
Practice Address - Phone:901-545-6299
Practice Address - Fax:901-545-7557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336S0011X
TN7443336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4413403OtherNCPDP
MS0030231Medicaid
2088380OtherPK
AR100828407Medicaid
TNQ032333Medicaid