Healthcare Provider Details

I. General information

NPI: 1750323457
Provider Name (Legal Business Name): JERKINS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 GILMER AVE
TALLASSEE AL
36078-2321
US

IV. Provider business mailing address

1405 GILMER AVE
TALLASSEE AL
36078
US

V. Phone/Fax

Practice location:
  • Phone: 334-283-3120
  • Fax: 334-283-3126
Mailing address:
  • Phone: 334-283-3120
  • Fax: 334-283-3126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number112769
License Number StateAL

VIII. Authorized Official

Name: JEFF D JERKINS
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 334-749-3426