Healthcare Provider Details

I. General information

NPI: 1871522029
Provider Name (Legal Business Name): JIFFY WESTSIDE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 W MARKET ST
ATHENS AL
35611-4769
US

IV. Provider business mailing address

1204 W MARKET ST
ATHENS AL
35611-4769
US

V. Phone/Fax

Practice location:
  • Phone: 256-233-2307
  • Fax: 256-233-0865
Mailing address:
  • Phone: 256-233-2307
  • Fax: 256-233-0865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number111507
License Number StateAL

VIII. Authorized Official

Name: MR. TERRELL G MILBY
Title or Position: OWNER/VICE PRESIDENT
Credential: R.PH.
Phone: 25623323307