Provider Demographics
NPI:1700040326
Name:BOROUGHS, JOY DEANNA (RPH)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:DEANNA
Last Name:BOROUGHS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 WASHINGTON AVE STE P005
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-4550
Mailing Address - Country:US
Mailing Address - Phone:901-287-6050
Mailing Address - Fax:
Practice Address - Street 1:777 WASHINGTON AVE STE P005
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-4550
Practice Address - Country:US
Practice Address - Phone:901-287-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-13
Last Update Date:2008-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8623183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN8623OtherSTATE LICENSE NUMBER
AR7645OtherSTATE LICENSE NUMBER