Tri State RX, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

200460670A Issued in IN

Legal business name

TRI STATE RX, LLC

Practice address

4849 Pollack Ave
Evansville, IN 47715-5750

Phone

(812) 962-4664

Fax

(812) 962-4660

NPI assigned

Aug 25, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Mark Allen Haywood, RPH

Title

Pharmacy Manager

Phone

(812) 962-4664

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Nation's Medicines Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219622400000",
    "number": "1952558686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 BURLEW BLVD",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423036486",
            "telephone_number": "270-685-4931",
            "fax_number": "270-685-5742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4849 POLLACK AVE",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477155750",
            "telephone_number": "812-962-4664",
            "fax_number": "812-962-4660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI STATE RX, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-25",
        "last_updated": "2008-08-25",
        "status": "A",
        "authorized_official_last_name": "HAYWOOD",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "812-962-4664",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IN",
            "license": "200460670A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200460670A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nation's Medicines",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Karen Trevino, M.D.
• Meghan Elizabeth Trevino, LCSW
• Tri State Community Clinic, LLC
• Tri State Immunization Group Inc
• Tri State Internal Medicine Source
• Tri State Transportation
• Tri-State Anesthesiologists, PC
• Tri-State Arthritis & Rheumatology Center, LLC
• Tri-State Colorectal Group, LLC
• Tri-State Dermatology & Skin Care, LLC

• Durable Medical Equipment & Medical Supplies in Evansville, IN
• Providers in Evansville, IN by specialty
• Durable Medical Equipment & Medical Supplies in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.