Healthcare Provider Details

I. General information

NPI: 1417018698
Provider Name (Legal Business Name): JEFFCO RUTLEDGE DRUGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 RUTLEDGE PIKE
RUTLEDGE TN
37861-0406
US

IV. Provider business mailing address

PO BOX 406
RUTLEDGE TN
37861-0406
US

V. Phone/Fax

Practice location:
  • Phone: 865-828-5222
  • Fax: 865-828-5959
Mailing address:
  • Phone: 865-828-5222
  • Fax: 865-828-5959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23997
License Number StateTN

VIII. Authorized Official

Name: JILL CABBAGE
Title or Position: PHARMACIST IN CHARGE/OWNER
Credential:
Phone: 865-828-5222