Organization
JEFF CITY PHARMACIST GROUP LLC DBA MD PHARMACY STORE 2
Active
Other names
Bunch Medical, LLC DBA MD Pharmacy Store 2, M.D. Pharmacy Store 2
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA R BLAKE PHARMD (PIC)
(865) 262-9777
Entity
Organization
Contact information
Practice address
657 E BROADWAY BLVD, JEFFERSON CITY, TN 37760
(865) 262-9777
(865) 262-9778
Mailing address
657 E BROADWAY BLVD, JEFFERSON CITY, TN 37760
(865) 262-9777
(865) 262-9778
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
5720
TN
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2157383
PK
—
05
—
Q033187
—
TN
Enumeration date
01/13/2016
Last updated
05/28/2020
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