Provider Demographics
NPI:1912312828
Name:ALLIANCE HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:ALLIANCE HEALTHCARE SERVICES
Other - Org Name:WHITNEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:LYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-354-7621
Mailing Address - Street 1:2150 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-6662
Mailing Address - Country:US
Mailing Address - Phone:901-354-7621
Mailing Address - Fax:901-354-7622
Practice Address - Street 1:2150 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-6662
Practice Address - Country:US
Practice Address - Phone:901-354-7621
Practice Address - Fax:901-354-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN00000053833336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146803OtherPK