MEDICARE: J & L STREET INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	2952	TN
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4428620	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871665679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J & L STREET INC

Provider Business Mailing Address
First Line	:	807 E JACKSON BLVD
Second Line	:
City	:	JONESBOROUGH
State	:	TN
Zip	:	37659-1507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	807 E JACKSON BLVD
Second Line	:
City	:	JONESBOROUGH
State	:	TN
Zip	:	37659-1507
Country	:	US
Telephone Number	:	423-753-2441
Fax Number	:	423-753-0477

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	KERI SIMERLY
Credential	:
Telephone Number	:	423-741-4231

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	03/07/2023

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Directions to “J & L STREET INC ” Practice Location

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