Healthcare Provider Details

I. General information

NPI: 1093776049
Provider Name (Legal Business Name): JERRY M. DUREN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 DEXTER L WOOD MEMORIAL DR
WAYNESBORO TN
38485-2416
US

IV. Provider business mailing address

215 DEXTER L WOOD MEMORIAL DR P. O. BOX 736
WAYNESBORO TN
38485-2416
US

V. Phone/Fax

Practice location:
  • Phone: 931-722-5466
  • Fax: 931-722-9495
Mailing address:
  • Phone: 931-722-5466
  • Fax: 931-722-9495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3411
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: