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.

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Contact Information

JEFF CITY PHARMACIST GROUP LLC DBA MD PHARMACY STORE 2

657 E BROADWAY BLVD
JEFFERSON CITY, TN 37760

Phone: 865-262-9777
Fax: 865-262-9778
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Pharmacy	333600000X	58	Medical Supply Company with Pharmacist
Community/Retail Pharmacy	3336C0003X	58	Medical Supply Company with Pharmacist

Indicates primary specialty

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

NPI Number 1073979522

LBN Legal business name JEFF CITY PHARMACIST GROUP LLC DBA MD PHARMACY STORE 2

Authorized official JOSHUA BLAKE - (PIC)

Entity Organization

Organization subpart ¹ No

Enumeration date 01/13/2016

Last updated 05/28/2020 - About 6 years ago

Identifiers

TN	License #	5720
TN	Medicaid	Q033187
	Other	2157383	PK

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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