Healthcare Provider Details

I. General information

NPI: 1780103242
Provider Name (Legal Business Name): FPJ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 08/02/2020
Certification Date: 08/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W MAIN ST
JACKSON TN
38301-6114
US

IV. Provider business mailing address

6 HOSPITAL DR
LEXINGTON TN
38351-1422
US

V. Phone/Fax

Practice location:
  • Phone: 731-265-6555
  • Fax: 731-265-6558
Mailing address:
  • Phone: 731-968-6979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number6060
License Number StateTN

VIII. Authorized Official

Name: SHERRY MIDDLETON
Title or Position: OWNER
Credential: PHARMD
Phone: 731-968-6979