=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710207188
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JERKINS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2010
-----------------------------------------------------
Last Update Date | 02/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4366 NOTASULGA RD
-----------------------------------------------------
City | TALLASSEE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36078-6035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-252-1688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4366 NOTASULGA RD
-----------------------------------------------------
City | TALLASSEE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36078-6035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-252-1688
-----------------------------------------------------
Fax | 334-252-1690
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JEFFREY D JERKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 334-252-1688
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 113373
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------