Organization
JACKSON MADISON COUNTY GENERAL
Active
Other names
Medsouth Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER VAUGHN (PHARMACY MANAGER)
(731) 287-4500
Entity
Organization
Contact information
Practice address
1700 WOODLAWN AVE, DYERSBURG, TN 38024-2028
(731) 287-4500
Mailing address
1700 WOODLAWN AVE, DYERSBURG, TN 38024-2028
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
00004608
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4442048
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/12/2009
Last updated
05/21/2009
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