Provider Demographics
NPI:1427478031
Name:USRC PHARMACY LLC
Entity type:Organization
Organization Name:USRC PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRANTLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WESCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-301-5953
Mailing Address - Street 1:525 METROPLEX DR STE 204
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-3140
Mailing Address - Country:US
Mailing Address - Phone:888-278-4988
Mailing Address - Fax:844-319-2263
Practice Address - Street 1:525 METROPLEX DR STE 204
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3140
Practice Address - Country:US
Practice Address - Phone:888-278-4988
Practice Address - Fax:844-319-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336C0003X
TN53773336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154750OtherPK