Provider Demographics
NPI:1972669240
Name:TRI MED PHARMACY SERVICES
Entity Type:Organization
Organization Name:TRI MED PHARMACY SERVICES
Other - Org Name:TRI MED PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:615-826-9393
Mailing Address - Street 1:PO BOX 9830
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-9830
Mailing Address - Country:US
Mailing Address - Phone:877-540-4748
Mailing Address - Fax:801-716-4872
Practice Address - Street 1:260 W MAIN ST
Practice Address - Street 2:STE 217
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3347
Practice Address - Country:US
Practice Address - Phone:615-826-9393
Practice Address - Fax:615-824-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30893336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4429999OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TN=========Medicaid