MEDICARE: KIZER PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	10005	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4073242	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1154388890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIZER PHARMACY LLC

Provider Business Mailing Address
First Line	:	1117 S MILES AVE
Second Line	:	STE. 1
City	:	UNION CITY
State	:	TN
Zip	:	38261-5439
Country	:	US
Telephone Number	:	731-885-2226
Fax Number	:	731-885-2291

Provider Business Practice Location Address
First Line	:	1117 S MILES AVE
Second Line	:	STE. 1
City	:	UNION CITY
State	:	TN
Zip	:	38261-5439
Country	:	US
Telephone Number	:	731-885-2226
Fax Number	:	731-885-2291

Authorized Official
Title or Position	:	OWNER/ PRESIDENT
Name	:	DR. JASON SMITH KIZER
Credential	:	PHARM.D
Telephone Number	:	731-885-2226

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	11/03/2008

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Directions to “KIZER PHARMACY LLC ” Practice Location

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