Provider Demographics
NPI:1942453220
Name:RESTORE RX INC
Entity Type:Organization
Organization Name:RESTORE RX INC
Other - Org Name:RESTORE RX, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:855-265-8008
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:TN
Mailing Address - Zip Code:38014-0305
Mailing Address - Country:US
Mailing Address - Phone:901-388-0507
Mailing Address - Fax:901-388-0407
Practice Address - Street 1:5169 BRUNSWICK RD #305
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:TN
Practice Address - Zip Code:38014
Practice Address - Country:US
Practice Address - Phone:901-388-0507
Practice Address - Fax:901-388-0407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45783336C0003X
3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2117613OtherPK