Healthcare Provider Details

I. General information

NPI: 1881750156
Provider Name (Legal Business Name): PHIPPS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15385 HIGHLAND DR
MC KENZIE TN
38201-2501
US

IV. Provider business mailing address

15385 HIGHLAND DR
MC KENZIE TN
38201-2501
US

V. Phone/Fax

Practice location:
  • Phone: 731-352-0820
  • Fax: 731-352-2848
Mailing address:
  • Phone: 731-352-0820
  • Fax: 731-352-2848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3519
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1454465
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer
# 2
Identifier4434281
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP PROVIDER IDENTIFICATION NUMBER

VIII. Authorized Official

Name: JERRY R PHIPPS JR.
Title or Position: PRESIDENT AND CEO
Credential: PHARMD
Phone: 731-352-0820