Healthcare Provider Details

I. General information

NPI: 1669866604
Provider Name (Legal Business Name): RANDY KENNETH JERKINS PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 PATTERSON ST SUITE 119
NASHVILLE TN
37203-1562
US

IV. Provider business mailing address

2400 PATTERSON ST SUITE 119
NASHVILLE TN
37203-1562
US

V. Phone/Fax

Practice location:
  • Phone: 615-329-5029
  • Fax: 615-329-5081
Mailing address:
  • Phone: 615-329-5029
  • Fax: 615-329-5081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number6706
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: