Healthcare Provider Details

I. General information

NPI: 1174512750
Provider Name (Legal Business Name): SGJ & P INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516-B WEST MAIN STREET
SMITHVILLE TN
37166-0299
US

IV. Provider business mailing address

P. O. BOX 299
SMITHVILLE TN
37166-1118
US

V. Phone/Fax

Practice location:
  • Phone: 615-597-7822
  • Fax: 615-597-1112
Mailing address:
  • Phone: 615-597-7822
  • Fax: 615-597-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SARAH FUSON
Title or Position: OWNER PHARMACIST
Credential:
Phone: 615-597-7822