Provider Demographics
NPI:1316428410
Name:SHELBY COUNTY HEALTH CARE CORPORATION
Entity type:Organization
Organization Name:SHELBY COUNTY HEALTH CARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:901-545-7840
Mailing Address - Street 1:877 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2807
Mailing Address - Country:US
Mailing Address - Phone:901-545-7847
Mailing Address - Fax:901-545-7557
Practice Address - Street 1:1977 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-7713
Practice Address - Country:US
Practice Address - Phone:901-515-4646
Practice Address - Fax:901-515-4649
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHELBY COUNTY HEALTH CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-27
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ045253Medicaid
4451186OtherNCPDP
4451186OtherNCPDP