National Provider Identifier Database

JEFF CITY PHARMACIST GROUP LLC DBA MD PHARMACY STORE 2
Pharmacy

A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.


Contact Information

JEFF CITY PHARMACIST GROUP LLC DBA MD PHARMACY STORE 2
657 E BROADWAY BLVD
JEFFERSON CITY, TN37760
Phone: 865-262-9777
Fax: 865-262-9778
Website:
Specialty Taxonomy Code
* Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X

* Indicates primary specialty

NPI Profile & details for JEFF CITY PHARMACIST GROUP LLC DBA MD PHARMACY STORE 2

NPI Number 1073979522
Legal business name
LBN
JEFF CITY PHARMACIST GROUP LLC DBA MD PHARMACY STORE 2
Authorized official JOSHUA BLAKE - (PIC)
Entity Organization
Organization subpart No
Enumeration date 01/13/2016
Last updated 05/28/2020 - About 6 years ago
Sole proprietor1 Not specified
Identifiers
  • TN License #: 5720
  • TN Medicaid: Q033187
  • Other: 2157383 PK

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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