Provider Demographics
NPI:1992248702
Name:ANOVORX GROUP LLC
Entity type:Organization
Organization Name:ANOVORX GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, MANAGING MEMBER AND DIRE
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-201-5484
Mailing Address - Street 1:1710 SHELBY OAKS DR N
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-7403
Mailing Address - Country:US
Mailing Address - Phone:901-201-5470
Mailing Address - Fax:901-201-5465
Practice Address - Street 1:1710 SHELBY OAKS DR N STE 5
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7403
Practice Address - Country:US
Practice Address - Phone:901-201-5470
Practice Address - Fax:901-201-5465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017009958333600000X
TN59053336C0003X
AROS027613336C0003X
MS15077/7.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166497OtherPK