Provider Demographics
NPI:1891778841
Name:CARDINAL HEALTH 128 LLC
Entity Type:Organization
Organization Name:CARDINAL HEALTH 128 LLC
Other - Org Name:MMS SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-312-9852
Mailing Address - Street 1:202 CUMBERLAND BND
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1804
Mailing Address - Country:US
Mailing Address - Phone:866-716-5486
Mailing Address - Fax:615-244-2621
Practice Address - Street 1:202 CUMBERLAND BND
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1804
Practice Address - Country:US
Practice Address - Phone:615-467-6009
Practice Address - Fax:615-467-6008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN38863336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152113OtherPK
TN4153376Medicaid
TN4153376Medicaid