Healthcare Provider Details

I. General information

NPI: 1083798136
Provider Name (Legal Business Name): JAMES RICKY JONES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W MAIN ST
HOHENWALD TN
38462-1404
US

IV. Provider business mailing address

121 W MAIN ST
HOHENWALD TN
38462-1404
US

V. Phone/Fax

Practice location:
  • Phone: 931-796-5901
  • Fax: 931-796-5438
Mailing address:
  • Phone: 931-796-5901
  • Fax: 931-796-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number05113
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES R JONES
Title or Position: PHARMACIST
Credential:
Phone: 931-796-5901