Provider Demographics
NPI:1760838528
Name:MED RX PHARMACY PC
Entity Type:Organization
Organization Name:MED RX PHARMACY PC
Other - Org Name:PREEMINENT HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-693-7351
Mailing Address - Street 1:1356 UNION UNIVERSITY DR
Mailing Address - Street 2:STE G
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305
Mailing Address - Country:US
Mailing Address - Phone:731-300-7311
Mailing Address - Fax:731-300-7319
Practice Address - Street 1:1356 UNION UNIVERSITY DR
Practice Address - Street 2:STE G
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305
Practice Address - Country:US
Practice Address - Phone:731-300-7311
Practice Address - Fax:731-300-7319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 333600000X, 3336C0004X
TN5793333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160091OtherPK