JELLICO DRUG STORE INC (NPI# 1093753196) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093753196 |
| Entity Type | Organization |
| Organization Name | JELLICO DRUG STORE INC |
| Practice Address |
229 S Main St Jellico TN 37762-2018 |
| Practice Telephone | 4237846226 |
| Practice Fax Number | 4237842947 |
| Mailing Telephone | 4237846226 |
| Mailing Fax Number | 4237842947 |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2015-09-01 |
| Authorized Official Name | MR. JOHN BAIRD (OWNER / PHARMACIST / PRESIDENT) |
| Authorized Official Telephone | 4237846226 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332BP3500X |
Durable Medical Equipment & Medical Supplies Specialization: Parenteral & Enteral Nutrition |
Suppliers | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
472 | TN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 4407210 | 05 |
| Street Address |
229 S MAIN ST |
| City | JELLICO |
| State | TN |
| Zip Code | 37762-2018 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609968981 | John Walter Baird | Pharmacist | 229 S Main St, Jellico, TN 37762-2018 | 2006-09-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063992600 | Springs of Life | Psychologist | 185 Baker Street, Jellico, TN 37762 | 2018-08-14 |
| 1679666366 | Charles Henry Wilkens | Family Medicine | 131 Hospital Lane, Jellico, TN 37762 | 2006-10-02 |
| 1225096217 | Benjamin Wayne D'ooge | Emergency Medicine | 188 Hospital Lane, Jellico, TN 37762 | 2006-05-02 |
| 1770790065 | Dayspring Health Inc | Physician Assistant | 107 S Main St, Jellico, TN 37762 | 2007-05-17 |
| 1790856102 | Charles R Hayes | Nurse Anesthetist, Certified Registered | 188 Hospital Ln, Jellico, TN 37762 | 2006-11-10 |
| 1023022084 | Dayspring Health Inc | Obstetrics & Gynecology | 550 Sunset Trl, Jellico, TN 37762 | 2006-07-27 |
| 1174691315 | Family Drug Center Inc | Durable Medical Equipment & Medical Supplies | 248 S Main St, Jellico, TN 37762-2017 | 2006-12-04 |
| 1114442175 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 248 S Main St, Jellico, TN 37762-2017 | 2017-08-10 |
| 1598211401 | Jonathan Broyles | Pharmacist | 248 S Main St, Jellico, TN 37762-2017 | 2016-08-30 |
| 1184008005 | Rite Aid of Tennessee Inc | Durable Medical Equipment & Medical Supplies | 248 S Main St, Jellico, TN 37762-2017 | 2015-07-10 |
| Find all providers in zip 37762 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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| 1548886104 | Tumlin Rx, LLC | Pharmacy | 104 E Main Blvd, Church Hill, TN 37642-3724 | 2020-06-19 |
| 1366065278 | Life Well Pharmacy, LLC | Pharmacy | 2408 Susannah St Ste 3, Johnson City, TN 37601-1765 | 2020-05-27 |
| 1699398602 | Walgreen Co | Pharmacy | 262 Danny Thomas Pl Ste 100rx, Memphis, TN 38105-3678 | 2020-05-26 |
| 1053931881 | Jones & Joslin, Pllc | Pharmacy | 4249 Highway 411 Ste 5, Madisonville, TN 37354-1544 | 2020-04-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.