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General NPI Number Information
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NPI Number | 1831228618
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Entity Type | Organization
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Legal Business Name | JACKSON CLINIC PHARMACY INC
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 05/29/2015
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Provider Practice Location Address
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Address Line | 2863 HIGHWAY 45 BYP
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City | JACKSON
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State | TN
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Zip | 38305-3618
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Country | US
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Telephone | 731-664-8046
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Fax | 731-660-8339
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Provider Business Mailing Address
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Address Line | 2863 HIGHWAY 45 BYP
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City | JACKSON
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State | TN
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Zip | 38305-3618
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Country | US
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Telephone | 731-664-8046
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Fax | 731-660-8339
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE NOAH
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Name | JEAN GRAY HUNDERUP
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Credential | DPH
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Telephone | 731-664-8046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic 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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2987
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License Number State | TN
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