Organization
JELLICO DRUG STORE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN BAIRD (OWNER / PHARMACIST / PRESIDENT)
(423) 784-6226
Entity
Organization
Contact information
Practice address
229 S MAIN ST, JELLICO, TN 37762-2018
(423) 784-6226
(423) 784-2947
Mailing address
229 S MAIN ST, JELLICO, TN 37762-2018
(423) 784-6226
(423) 784-2947
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
3336C0003X
Community/Retail Pharmacy
Primary
472
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4407210
—
TN
Enumeration date
06/02/2006
Last updated
09/01/2015
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