Healthcare Provider Details

I. General information

NPI: 1871587642
Provider Name (Legal Business Name): TJT PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 4TH ST
FULTON IL
61252-1716
US

IV. Provider business mailing address

1016 4TH ST
FULTON IL
61252-1716
US

V. Phone/Fax

Practice location:
  • Phone: 815-589-2233
  • Fax: 815-589-4789
Mailing address:
  • Phone: 815-589-2233
  • Fax: 815-589-4789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name: TERRY TUFTY
Title or Position: PRESIDENT
Credential:
Phone: 815-589-2233