Organization
WINDHAM DRUG JELLICO, INC
Active
Other names
Windham Drug Jellico
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN SMITH PHARM.D. (VICE-PRESIDENT)
(423) 784-3630
Entity
Organization
Contact information
Practice address
1184 5TH ST, JELLICO, TN 37762-2629
(423) 784-3630
Mailing address
1184 5TH ST, JELLICO, TN 37762-2629
(423) 784-3630
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
TN
Other
Enumeration date
05/03/2017
Last updated
05/03/2017
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