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General NPI Number Information
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NPI Number | 1538306634
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Entity Type | Organization
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Legal Business Name | JACKSON MADISON COUNTY GENERAL
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Dates
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Enumeration Date | 01/12/2009
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Last Update Date | 05/21/2009
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Provider Practice Location Address
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Address Line | 1700 WOODLAWN AVE
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City | DYERSBURG
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State | TN
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Zip | 38024-2028
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Country | US
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Telephone | 731-287-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 WOODLAWN AVE
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City | DYERSBURG
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State | TN
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Zip | 38024-2028
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | JENNIFER VAUGHN
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Credential |
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Telephone | 731-287-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 00004608
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License Number State | TN
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