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General NPI Number Information
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NPI Number | 1700971264
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Entity Type | Organization
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Legal Business Name | PHIPPS PHARMACY INC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 19 HUGHES DR
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City | JACKSON
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State | TN
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Zip | 38305-1510
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Country | US
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Telephone | 731-668-9072
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Fax | 731-664-9076
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Provider Business Mailing Address
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Address Line | 205B HOSPITAL DR
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City | MC KENZIE
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State | TN
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Zip | 38201-1649
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Country | US
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Telephone | 731-352-0820
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Fax | 731-352-2848
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Authorized Official
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Title or Position | PHARMACIST/PRESIDENT/CEO
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Name | DR. JERRY ROBERT PHIPPS JR.
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Credential | PHARM D.
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Telephone | 731-352-0820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 308
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 308
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 308
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License Number State | TN
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