Organization
JACKSON MADISON COUNTY GENERAL
Active
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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