Provider Demographics
NPI:1205259413
Name:FIRST PHARMACY SERVICES OF DIRECTORS ROW
Entity type:Organization
Organization Name:FIRST PHARMACY SERVICES OF DIRECTORS ROW
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:901-346-4306
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:POPE
Mailing Address - State:MS
Mailing Address - Zip Code:38658-0047
Mailing Address - Country:US
Mailing Address - Phone:901-346-4306
Mailing Address - Fax:901-346-4308
Practice Address - Street 1:3171 DIRECTORS ROW
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38131-0405
Practice Address - Country:US
Practice Address - Phone:901-346-4306
Practice Address - Fax:901-346-4308
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST PHARMACY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-23
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
TN3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy